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| - | =======Lower Respiratory Infections (LPI) Powerpoint======= | + | ====== Lower Respiratory Infections (LRI) Powerpoint====== |
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| The global burden of disease measures the burden of a specific disease using the disability-adjusted-life-year (DALY) measurement. This measure combines the years of life lost due to premature mortality and the years of life lost due to time lived in states of less than full health. | The global burden of disease measures the burden of a specific disease using the disability-adjusted-life-year (DALY) measurement. This measure combines the years of life lost due to premature mortality and the years of life lost due to time lived in states of less than full health. | ||
| - | Lower respiratory tract infections (LRTIs) are one of the prevalent and troublesome diseases around the world. There are numerous different types of LRTIs but the most common ones are: pneumonia, and bronchitis. | + | <box 57% round| > {{:DALYs.png|}} </box| Figure 1 : A visual depiction of DALYs where red represents years lived in disability, and green represents years of life lost due to premature death.> |
| - | LRTIs are one of the most frequent reasons for pediatric visits and hospitalization for children. (El-Azami-El-Idrissi et al., 2016). In addition, males are more susceptible than females for LRTIs (Falagas, Mourtzoukou, & Vardakas, 2007). | ||
| - | ==== Coronary Artery Disease ==== | + | Lower respiratory tract infections (LRTIs) are one of the prevalent and troublesome diseases around the world. There are numerous different types of LRTIs, but the most common ones are pneumonia and bronchitis. |
| - | Coronary Artery disease (CAD), also known as Coronary Heart Disease (CHD) and Ischaemic heart disease is the largest contributor to cardiovascular diseases (Wong 2014). The diseases are characterized by: angina (chest pain), shortness of breath and myocardial infarction which may contribute to patient mortality. One of the main causes of CAD is atherosclerosis which is characterized by gradual thickening of the coronary artery walls. This occurs when plaque, composed of debris, fat and organic substances accumulates inside the arterial walls, leading to narrowing and hardening of the blood vessels. | + | LRTIs are one of the most frequent reasons for pediatric visits and hospitalization for children. (El-Azami-El-Idrissi et al., 2016). Also, males are more susceptible than females for LRTIs (Falagas, Mourtzoukou, & Vardakas, 2007). |
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| - | Other risk factors include hypertension, cigarette smoking, diabetes mellitus or elevated glucose levels, increased cholesterol levels, and obesity (Wong, 2014). Specifically, a dangerous combination of poor nutrition and lack of physical exertion can lead to many of these risk factors. Current research suggests preventive measures are the most beneficial in reducing an individual's risk for developing CAD; this includes proper nutrition and doing regular exercise. Furthermore, additional treatment options include the use of medication such as beta blockers, nitrates, angiotensin converting enzyme (ACE) inhibitors, and antiplatelets. Surgery is a more invasive option for those afflicted with multiple blockages and the goal is to improve circulation of blood towards the heart. | + | |
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| - | <box 72% round | > {{:w11.jpg|}} </box| Figure 2 : Pie Chart Representing the Major Contribution of Ischemic Heart Disease as Compared with Other Cardiovascular Diseases. (Wong, 2014)> | + | |
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| ====== Epidemiology ====== | ====== Epidemiology ====== | ||
| - | According to the World Health Organization (n.d.), LRTIs account for the second largest global burden of disability adjusted life years (DALYs) in 2012. Since 2000, the global burden associated with LRTI has decreased by nearly 30% (WHO, n.d.). Unfortunately, roughly 95% of the episodes of childhood clinical pneumonia occur in developing nations (Rudan, Boschi-Pinto, Biloglav, Mulholland, & Campbell, 2008). In addition, it is estimated that childhood pneumonia is the single leading cause of childhood mortality (Rudan, Boschi-Pinto, Biloglav, Mulholland, & Campbell, 2008). | + | According to the World Health Organization (n.d.), LRTIs account for the second largest global burden of disability-adjusted life years (DALYs) in 2012. Since 2000, the global burden associated with LRTI has decreased by nearly 30% (WHO, n.d.). Unfortunately, roughly 95% of the episodes of childhood clinical pneumonia occur in developing nations (Rudan, Boschi-Pinto, Biloglav, Mulholland, & Campbell, 2008). In addition, it is estimated that childhood pneumonia is the single leading cause of childhood mortality (Rudan, Boschi-Pinto, Biloglav, Mulholland, & Campbell, 2008). |
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| - | Unfortunately, Canada is not immune to the detrimental impact of LRTIs. In fact, Inuit infants within Canada have some of highest hospital admissions as a result of LRTIs in the entire world (Kovesi et al., 2007). More specifically, a recent study found that the annualized incidence rate of admission to hospital for LRTI for a particular Inuit population located on Baffin Island was 484 per 1000 infants under the age of 6 months (Banerji et al., 2001). After extensive research, it was determined that indoor air pollution, reduced ventilation, and overcrowding within an household are all risk factors associated with LRTI that are prevalent in most Inuit communities in Canada (Kovesi et al., 2007). | + | |
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| - | <box 49% round| > {{:w10.jpg|}} </box| Figure 3 : Bar Graph Indicating Increased Prevalence of Atrial Fibrillation in Men vs Women. (Benjamin et al., 2014)> | + | |
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| - | ==== Prevalence and Mortality Rate ==== | + | |
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| - | The 2016 Heart Disease and Stroke Statistics update of the American Heart Association reported that 15.5 million people over 20 years of age in the USA have CAD, with the prevalence increasing with age for both sexes (Sanchis-Gomar et al, 2016). The results of the data collected on CAD and MI is illustrated in the graphs where the prevalence for men is observed to be much greater than women. | + | |
| - | Furthermore, in a 2009 report based on data from National Health and Nutritional Survey (NHANES), myocardial infarction prevalence was observed in middle aged individual (35-45 years of age) during the 1988-1994 and 1999-2004 time periods. The results indicated a higher prevalence in men compared to women, but the trend declined for the former over time. | + | Unfortunately, Canada is not immune to the detrimental impact of LRTIs. In fact, Inuit infants within Canada have some of highest hospital admissions as a result of LRTIs in the entire world (Kovesi et al., 2007). More specifically, a recent study found that the annualized incidence rate of admission to hospital for LRTI for a particular Inuit population located on Baffin Island was 484 per 1000 infants under the age of 6 months (Banerji et al., 2001). After extensive research, it was determined that indoor air pollution, reduced ventilation, and overcrowding within a household are all risk factors associated with LRTI that are prevalent in most Inuit communities in Canada (Kovesi et al., 2007). |
| - | + | <box 56% round| > {{:Baffin.png|}} </box| Figure 2 : Baffin Island, which has some of the worst LRTI rates in the world. Retrieved from: https://encrypted-tbn3.gstatic.com/images?q=tbn:ANd9GcQ3VU-2zllZKj0gv4Ww9NXrTf7mXMTXZVvW7_G-yR5OElvwp_HSm-bes9Y | |
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| - | <box 88% round | > {{:w07.jpg|}} </box| Figure 4 : Pie Chart Representing the Major Contribution of Ischemic Heart Disease as Compared with Other Cardiovascular Diseases. (Wong, 2014)> | + | |
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| - | ==== Global and Regional DALY ==== | + | |
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| - | The World Health Organization released estimates of the global and regional burden of disease, which included 20 leading causes. The data was collected for 2000 and 2012, with a reported increase in DALY being observed both globally and in regions such as Southeast Asia, the Eastern Mediterranean and the western pacific region. The global rank of ischemic heart disease increased from being the third leading cause of death in 2000 to the first leading cause of death in 2012 (World Health Organization, n.d.) Although the global burden of coronary artery disease was dominant in western countries during the early 20th century, the burden now lies in specific Asian and middle-Eastern regions (Wong 2014). The global ischemic heart disease DALY data collected for both sexes indicates a high concentration in Central Asia, North Africa and West Europe. | + | |
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| - | <box 44% round | > {{:w02.jpg|}} </box| Figure 5 : Observed Increase in Global DALY Measurement (WHO, n.d.)> | + | |
| - | <box 44% round | > {{:w01.jpg|}} </box| Figure 6 : Observed Increase in South-East Asian DALY Measurement (WHO, n.d.)> | + | |
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| ==== Lower respiratory system anatomy ==== | ==== Lower respiratory system anatomy ==== | ||
| - | <box 45% round | > {{:snip20170305_3.png}} </box|Figure 7: Lower Respiratory System anatomy. Retrieved from https://www.slideshare.net/albertpg01/respiratory-system-39466744> | + | <box 50% round | > {{:snip20170305_3.png}} </box|Figure 3: Lower Respiratory System anatomy. Retrieved from https://www.slideshare.net/albertpg01/respiratory-system-39466744> |
| The lower respiratory system consists of the trachea, the bronchi and bronchioles and the alveoli which make up the lungs (Medicine plus, 201). The trachea, which is the largest tube in the respiratory tract, branches off into two bronchial tubes known as bronchus. The tubes of the bronchi branch subdivide further into secondary and tertiary bronchi and then into bronchioles. The ends of the bronchioles give rise to microscopic air sacs known as alveoli. Hundreds of alveoli exist inside each lung (Medicine plus, 201). | The lower respiratory system consists of the trachea, the bronchi and bronchioles and the alveoli which make up the lungs (Medicine plus, 201). The trachea, which is the largest tube in the respiratory tract, branches off into two bronchial tubes known as bronchus. The tubes of the bronchi branch subdivide further into secondary and tertiary bronchi and then into bronchioles. The ends of the bronchioles give rise to microscopic air sacs known as alveoli. Hundreds of alveoli exist inside each lung (Medicine plus, 201). | ||
| - | The primary function of the respiratory system is to exchange oxygen and carbon dioxide between the body and environment and it takes place in the alveoli, also known as air sacs found in the lungs (Inglis, 2007). Therefore, the respiratory tract is constantly exposed to microorganisms such as bacteria, viruses and fungi. The majority of particles are filtered out in the nasal hairs and by the inertial impaction, which is covered by mucus found in the posterior nasopharynx. The epiglottis applies a closure and cough reflex to reduce the risk of microorganisms reaching the lower respiratory tract. However, if small enough particles have reached the trachea and bronchi they then stick to the respiratory mucus lining their walls and are propelled towards the oropharynx by the cilia. Then, antimicrobial factors such as lysozyme, lactoferrin and secretory IgA present in respiratory secretions disable inhaled microorganisms from reaching further into the lungs (Inglis, 2007). | + | The primary function of the respiratory system is to exchange oxygen and carbon dioxide between the body and environment, and it takes place in the alveoli, also known as air sacs found in the lungs (Inglis, 2007). Therefore, the respiratory tract is constantly exposed to microorganisms such as bacteria, viruses, and fungi. The majority of particles are filtered out in the nasal hairs and by the inertial impaction, which is covered by mucus found in the posterior nasopharynx. The epiglottis applies a closure and cough reflex to reduce the risk of microorganisms reaching the lower respiratory tract. However, if small enough particles have reached the trachea and bronchi they then stick to the respiratory mucus lining their walls and are propelled towards the oropharynx by the cilia. Then, antimicrobial factors such as lysozyme, lactoferrin and secretory IgA present in respiratory secretions disable inhaled microorganisms from reaching further into the lungs (Inglis, 2007). |
| - | <box 40% round | > {{:snip3_2.png}} </box|Figure 7: Defences of the respiratory tract (Inglis, 2007).> | + | <box 43% round | > {{:snip3_2.png}} </box|Figure 4: Defences of the respiratory tract (Inglis, 2007).> |
| - | However, particles ranging from about 5-10 µm may be able to get further into the respiratory system into the alveolar air sacs (Inglis, 2007). Once they reach the alveolar air sacs, the alveolar macrophages phagocytose the pathogens and the neutrophils may also be activated through the inflammatory response (Inglis, 2007). | + | However, particles ranging from about 5-10 µm may be able to get further into the respiratory system into the alveolar air sacs (Inglis, 2007). Once they reach the alveolar air sacs, the alveolar macrophages phagocytose the pathogens, and the neutrophils may also be activated through the inflammatory response (Inglis, 2007). |
| ===Causes of LRI=== | ===Causes of LRI=== | ||
| - | Nevertheless, pathogens have developed strategies to overcome the defence mechanisms in the respiratory system. For example, Streptococcus pneumonia, a gram positive bacteria and Haemophilus influenzae, a gram-negative bacteria both produce an enzyme known as IgA protease, which is capable of disabling mucosal IgA (Inglis, 2007). Streptococcus pneumonia and Haemophilus influenzae which are primarily known to cause pneumonia, in addition to other bacteria are resistant to phagocytosis. Therefore, they are able to get passed the defence mechanisms and penetrate to the lungs. Some microorganisms also release toxins which can cause further damage to the alveolar walls (Inglis, 2007). | + | Nevertheless, pathogens have developed strategies to overcome the defense mechanisms in the respiratory system. For example, Streptococcus pneumonia, a gram-positive bacteria, and Haemophilus influenzae, a gram-negative bacteria both produce an enzyme known as IgA protease, which is capable of disabling mucosal IgA (Inglis, 2007). Streptococcus pneumonia and Haemophilus influenzae which are primarily known to cause pneumonia, in addition to other bacteria are resistant to phagocytosis. Therefore, they are able to get passed the defense mechanisms and penetrate to the lungs. Some microorganisms also release toxins which can cause further damage to the alveolar walls (Inglis, 2007). |
| - | <box 25% round | > {{:strept.jpeg}} </box|Figure 7: Streptococcus pneumonia Retrieved from: http://www.newhealthadvisor.com/streptococcus-pneumoniae.html> | + | <box 28% round right | > {{:strept.jpeg}} </box|Figure 5: Streptococcus pneumonia Retrieved from: http://www.newhealthadvisor.com/streptococcus-pneumoniae.html> |
| - | Pneumonia can develop after inhalation of microorganisms primarily bacteria, viruses and fungi or when bacteria from an infection elsewhere in the body spreads to the lungs, which overpower your immune system, thus infecting your lungs (Mayo Clinic, 2016). It is characterized by inflammation of the air sacs or alveoli, which are microscopic sacs in the lungs that absorb oxygen. The inflammation causes the alveoli to fill with fluid reducing the amount of air space space in the lungs for air and so the air coming is unable to exchange (Mayo Clinic, 2016). | + | Pneumonia can develop after inhalation of microorganisms primarily bacteria, viruses, and fungi or when bacteria from an infection elsewhere in the body spreads to the lungs, which overpower your immune system, thus infecting your lungs (Mayo Clinic, 2016). It is characterized by inflammation of the air sacs or alveoli, which are microscopic sacs in the lungs that absorb oxygen. The inflammation causes the alveoli to fill with fluid reducing the amount of air space in the lungs for air, and so the air coming is unable to exchange (Mayo Clinic, 2016). |
| - | <box 40% round | > {{:pneumonia_anatomy.jpg}} </box|Figure 7: Pneumonia causes an Inflammation in the air sacs or alveoli of the lungs. Retrieved from: http://medicalassessmentonline.com/terms.php?R=323&L=L> | + | <box 40% round | > {{:pneumonia_anatomy.jpg}} </box|Figure 6: Pneumonia causes an Inflammation in the air sacs or alveoli of the lungs. Retrieved from: http://medicalassessmentonline.com/terms.php?R=323&L=L> |
| ===Community and Hospital Acquired Pneumonia=== | ===Community and Hospital Acquired Pneumonia=== | ||
| - | Community acquired pneumonia (CAP) is the most common type of pneumonia, which occurs outside of the hospital setting. It is caused by bacteria, fungi and viruses. The most common cause of bacterial pneumonia is streptococcus pneumonia, and it usually occurs on its own or after having a cold or flu. Pneumonia caused by fungi is common in people with weak immune systems or chronic health problems and in those who have inhaled large doses of the organism. Viruses that cause cold and flu can cause pneumonia as well. In addition, viruses are the most common case of pneumonia in children (Mayo Clinic, 2016). | + | Community-acquired pneumonia (CAP) is the most common type of pneumonia, which occurs outside of the hospital setting. It is caused by bacteria, fungi, and viruses. The most common cause of bacterial pneumonia is streptococcus pneumonia, and it usually occurs on its own or after having a cold or flu. Pneumonia caused by fungi is common in people with weak immune systems or chronic health problems and in those who have inhaled large doses of the organism. Viruses that cause cold and flu can cause pneumonia as well. Also, viruses are the most common case of pneumonia in children (Mayo Clinic, 2016). |
| - | Pneumonia occurring during a hospital stay for another illness, is termed hospital associated pneumonia (HAP). It is mostly caused by a bacteria then by a virus.The bacteria causing the pneumonia, may become resistant to antibiotics, making it dangerous. | + | Pneumonia occurring during a hospital stay for another illness is termed hospital-associated pneumonia (HAP). It is mostly caused by a bacteria then by a virus.The bacteria causing the pneumonia may become resistant to antibiotics, making it dangerous. |
| - | Ventilator-associated pneumonia is a type of HAP, which occurs in patients receiving mechanical ventilation through an endotracheal tube or tracheostomy (Amanullah, 2015). Thus, the mechanical ventilation increases the risk of developing bacterial pneumonia because it allows free passage of bacteria into the lower segments of the lung through the endotracheal tube and around the cuff which then enter the lungs with each breath (Amanullah, 2015). | + | Ventilator-associated pneumonia is a type of HAP, which occurs in patients receiving mechanical ventilation through an endotracheal tube or tracheostomy (Amanullah, 2015). Thus, the mechanical ventilation increases the risk of developing bacterial pneumonia because it allows free passage of bacteria into the lower segments of the lung through the endotracheal tube and around the cuff which then enters the lungs with each breath (Amanullah, 2015). |
| - | <box 40% round | > {{:vap.png}} </box|Figure 7: Ventilator Associated Pneumonia. Retrieved from: http://speciality.medicaldialogues.in/preventing-ventilator-associated-pneumonia-in-hospitals-goi-guidelines/> | + | <box 39% round | > {{:vap.png}} </box|Figure 7: Ventilator Associated Pneumonia. Retrieved from: http://speciality.medicaldialogues.in/preventing-ventilator-associated-pneumonia-in-hospitals-goi-guidelines/> |
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| ==== Symptoms ==== | ==== Symptoms ==== | ||
| - | The symptoms of pneumonia can vary from mild to severe. Many of the mild symptoms are very similar to that of a cold, however they would last longer. Some of the symptoms of pneumonia may include; cough (some may cough up greenish or yellow mucus or bloody mucus) , nausea and vomiting, shortness of breath, chest pain which gets worse when you breath deeply or cough, rapid breathing, shaking chills and fever which may be mild or high (Mayo Clinic, 2016);(American Lung Association, 2016). | + | The symptoms of pneumonia can vary from mild to severe. Many of the mild symptoms are very similar to that of a cold. However, they would last longer. Some of the symptoms of pneumonia may include; cough (some may cough up greenish or yellow mucus or bloody mucus) , nausea and vomiting, shortness of breath, chest pain which gets worse when you breath deeply or a cough, rapid breathing, shaking chills and fever which may be mild or high (Mayo Clinic, 2016);(American Lung Association, 2016). |
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| ====== Diagnosing CAD ====== | ====== Diagnosing CAD ====== | ||
| - | Typically, if a patient displays symptoms (shortness of breath, angina, etc) they would be referred to do one of these diagnostic tests to determine the presence of CAD. There are numerous diagnostic tests available for determining the presence of CAD, these include: electrocardiogram (ECG), echocardiogram, exercise stress test, and coronary angiogram. | + | The first indication of lower respiratory tract infections is due to a recurring cough and chest irritation which does not stop after a short period of time. A physician will typically suspect an LTRI if the patient exhibits unusual wheezing or sound in the lungs (Mayo Clinic, 2014). The most important distinction to make when diagnosing an LTRI is to differentiate between a pneumonic and non-pneumonic condition. This will be important in helping to determine the course of treatment and severity of the infection. The main method of diagnosis without a chest radiograph is to focus on the category of symptoms (Anderson & Winter, 2009). |
| - | An ECG and echocardiogram are both non-invasive techniques and simply image the heart at rest (Mayo Clinic, n.d.). If a patient displays symptoms during exercise, an exercise stress test may be ordered (Mayo Clinic, n.d.). All of these tests can determine if a patient has CAD but typically more testing needs to be done to be absolutely sure. If either one of these tests is positive, a patient is referred for an Coronary Angiogram which is considered the gold standard for diagnosing CAD (Bogle, n.d.). | + | Physicians rely on other tests as will, such as painless skin monitoring to determine if the oxygen concentration in the patient's blood is lower than normal. Furthermore, blood tests can be performed to check for an elevated white blood cell count which would indicate a reaction to a virus, bacteria or another pathogen. The most popular method of diagnosing an LTRI, specifically pneumonia is a chest x-ray to check for the presence of fluid in the air-filled sacs (Mayo Clinic, 2014). The X-ray assists physicians in ruling out other causes of the symptoms such as acute bronchitis or a lung mass. |
| - | As you can tell, many of these diagnostic techniques require complex machines and the expertise of healthcare professionals to properly determine the presence or absence of disease. The combination of these two factors may be simply impractical for many living in impoverished communities around the world. Thus, without the proper tools to diagnose CAD, the current statistics for the global burden of this disease may actually severely underestimate its truly devastating impact. | + | Interestingly, the practice guidelines of the American Thoracic Society (AST) and the Infectious Disease Society of America (IDSA) places emphasis on using patient's history and physical examination for diagnosis (Carrol, 2002). Lastly, microbiological tests have seen an increase in use due to the ease and accuracy of the tests performed. They require collection of sputum, which is a mixture of saliva and mucus coughed up from the respiratory tract. For example, Streptococcus pneumoniae, the bacteria which causes pneumonia is tested for by performing gram stains and cultures. Also, bacterial urinary antigen tests are available as they are highly specific and sensitive (Carrol, 2002). Overall, physicians rely on traditional methods for diagnosis of the disease, although laboratory tests are favored for their accuracy and ease of specimen collection. |
| - | <box 38% round| > {{:angio.png|}} </box| Figure 9: Coronary angiogram. Retrieved from: http://www.richardbogle.com/coronary-angiography.html > | + | <box 60% round| > {{:pneumonialungs.png|}} </box| Figure 8: Healthy lungs (LS) vs. lungs affected by pneumonia (RS). Retrieved from: https://www.med-ed.virginia.edu/courses/rad/cxr/pathology3chest.html > |
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| ====== Risk Factors ====== | ====== Risk Factors ====== | ||
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| Individuals can also have a higher risk of developing pneumonia if they have had a recent viral respiratory infection (such as a cold or flu), or if they have a chronic lung or other serious disease such as cystic fibrosis, COPD, diabetes, or sickle cell disease (Healthline, 2015). Diseases such as these increase risk because they make breathing difficult, block airways, and have symptoms that are similar to and can be exacerbated by pneumonia (Healthline, 2015). In addition, individuals with these diseases may also be prescribed immunosuppressant drugs such as inhaled corticosteroids (Healthline, 2015). Having a cold or flu can cause bacterial pneumonia to develop on its own, most commonly from the Streptococcus pneumoniae bacteria (Mayo Clinic, 2016). | Individuals can also have a higher risk of developing pneumonia if they have had a recent viral respiratory infection (such as a cold or flu), or if they have a chronic lung or other serious disease such as cystic fibrosis, COPD, diabetes, or sickle cell disease (Healthline, 2015). Diseases such as these increase risk because they make breathing difficult, block airways, and have symptoms that are similar to and can be exacerbated by pneumonia (Healthline, 2015). In addition, individuals with these diseases may also be prescribed immunosuppressant drugs such as inhaled corticosteroids (Healthline, 2015). Having a cold or flu can cause bacterial pneumonia to develop on its own, most commonly from the Streptococcus pneumoniae bacteria (Mayo Clinic, 2016). | ||
| - | <box 30% round right| > {{:ICU.jpg|}} </box| Figure 10 - ICU Ventilators, one of the methods in which an individual can contract hospital-acquired pneumonia. Retrieved from: http://medsunhealthcare.com/wp-content/uploads/2015/11/4.-ICU-Ventilator.jpg> | + | <box 48% round right| > {{:ICU.jpg|}} </box| Figure 9: ICU Ventilators, one of the methods in which an individual can contract hospital-acquired pneumonia. Retrieved from: http://medsunhealthcare.com/wp-content/uploads/2015/11/4.-ICU-Ventilator.jpg> |
| ====Lifestyle Risk Factors==== | ====Lifestyle Risk Factors==== | ||
| - | There are many lifestyle-related habits that can influence an individual’s risk of developing pneumonia. In healthy young individuals, smoking cigarettes is the largest risk factor for developing pneumonia (NHLBI, 2016). Alcohol abuse can also increase an individual’s chance of developing pneumonia because long-term alcohol use lowers levels of the white blood cells that can fend off pneumonia (NHLBI, 2016). Other conditions, such as having HIV/AIDS, an organ or blood/marrow transplant, chemotherapy, or long-term steroid use all increase risk as well as they weaken or suppress the immune system (NHLBI, 2016). Being undernourished can also increase risk levels for the same reason (NHLBI, 2016). | + | There are many lifestyle-related habits that can influence an individual’s risk of developing pneumonia. In healthy young individuals, smoking cigarettes is the largest risk factor for developing pneumonia (NHLBI, 2016). Alcohol abuse can also increase an individual’s chance of developing pneumonia because long-term alcohol use lowers levels of the white blood cells that can fend off pneumonia (NHLBI, 2016). Other conditions, such as having HIV/AIDS, an organ or blood/marrow transplant, chemotherapy, or long-term steroid use all increase risk as well, as they weaken or suppress the immune system (NHLBI, 2016). Being undernourished can also increase risk levels for the same reason (NHLBI, 2016). |
| - | Risk can also be increased if an individual is exposed regularly to chemicals, pollutants, or fumes (WHO, 2016). Indoor air pollution caused by cooking, asbestos, or heating using biomass fuels (wood, dung) can both increase risk (WHO, 2016). Air pollution in the form of second-hand smoke can also increase an individual’s risk of developing pneumonia (WHO, 2016). Fungal-based pneumonia can also develop if an individual is exposed frequently to fungi found in bird droppings or soil (Mayo Clinic, 2016). | + | Risk can also be increased if an individual is regularly exposed to chemicals, pollutants, or fumes (WHO, 2016). Indoor air pollution caused by cooking, asbestos, or heating using biomass fuels (wood, dung) can both increase risk (WHO, 2016). Air pollution in the form of second-hand smoke can also increase an individual’s risk of developing pneumonia (WHO, 2016). Fungal-based pneumonia can also develop if an individual is frequently exposed to fungi found in bird droppings or soil (Mayo Clinic, 2016). |
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| ====== Treatments====== | ====== Treatments====== | ||
| - | CAD can be treated through pharmacological options (medications), medical procedures and lifestyle modifications. According to data comparing CAD deaths from the 1980’s and 2000, it was estimated that about 47% of the decline in CAD deaths was attributed to treatments (Llyod-Jones et al., 2010). | + | The treatments for pneumonia can be categorized into lifestyle modifications, pharmacological options, and medical procedures. |
| - | ====Pharmacological Alternatives==== | + | ====Lifestyle Modifications==== |
| - | There are numerous medications available that are used to lower blood pressure and prevent blood clots from forming which ultimately reduces your chances of mortality from CAD. These medications include: beta blockers, nitrates, angiotensin converting enzyme (ACE) inhibitors, and antiplatelets. | + | Lifestyle modifications are important in the prevention and treatment of pneumonia. Pneumonia can be prevented through various vaccinations. A vaccination can be administered to prevent pneumococcal pneumonia, which is a common form of bacterial pneumonia (National Heart, Lung, and Blood Institute, 2016). Since pneumonia is commonly caused by the seasonal influenza, it is important to be vaccinated against it. Moreover, it is crucial to quit smoking as the tobacco damages the lung’s ability to fight off infection (National Heart, Lung, and Blood Institute, 2016). Healthy eating and regular exercise is important in keeping a strong immune system to effectively fight infections. |
| - | Beta blockers which include atenolol, metoprolol, nebivolol and bisoprolol are used to slow down the heartbeat and improve blood flow. Whereas, nitrates, often referred to as vasodilators are used to widen blood vessels and control angina symptoms. The ACE inhibitors, one of the most commonly used drugs are used in reducing the risks of a cardiovascular event, by lowering blood pressure. They work by blocking the conversion of angiotensin-I (AT-1) into angiotensin- II (AT-II) by blocking the main effects of AT-II which are; narrowing blood vessels and water and salt retention (Brugts et al.,2012). | + | ====Pharmacological Options==== |
| - | Another type of medicine commonly used is antiplatelet medicines include aspirin. Antiplatelet medicines are known to prevent the formation of blood clots. Aspirin, the most widely used antiplatelet agent is known to reduce the risks of vascular events by inhibiting platelet aggregation (Hennekens,Dyken & Fuster, 1997). | + | |
| - | There are numerous medications available that are used to lower blood pressure and prevent blood clots from forming which ultimately reduces your chances of mortality from CAD. These medications include: beta blockers, nitrates, angiotensin converting enzyme (ACE) inhibitors, and antiplatelets. | + | In the early stages of pneumonia, managing symptoms is equally important as curing pneumonia. Coughing is one of the body’s mechanisms to eliminate infection through the movement of mucus. Therefore, cough medications should be avoided, as they will suppress coughing. To relieve coughing, home remedies such as chewing garlic with honey can be implemented. Furthermore, drinking plenty of fluids will complement the treatment of pneumonia, as it will help loosen secretions and dilute phlegm. |
| - | Beta blockers which include atenolol, metoprolol, nebivolol and bisoprolol are used to slow down the heartbeat and improve blood flow. Whereas, nitrates, often referred to as vasodilators are used to widen blood vessels and control angina symptoms. The ACE inhibitors, one of the most commonly used drugs are used in reducing the risks of a cardiovascular event, by lowering blood pressure. They work by blocking the conversion of angiotensin-I (AT-1) into angiotensin- II (AT-II) by blocking the main effects of AT-II which are; narrowing blood vessels and water and salt retention (Brugts et al.,2012). Another type of medicine commonly used is antiplatelet medicines include aspirin. Antiplatelet medicines are known to prevent the formation of blood clots. Aspirin, the most widely used antiplatelet agent is known to reduce the risks of vascular events by inhibiting platelet aggregation (Hennekens,Dyken & Fuster, 1997). | + | The type of pharmacological treatment used to cure pneumonia depends on the type and severity of pneumonia. The goal of medications is to cure the respiratory infection and prevent complications. Pneumonia caused by bacteria is treated with antibiotics like azithromycin, clarithromycin and erythromycin (National Heart, Lung, and Blood Institute, 2016). These antibiotics bind to the bacterial 50S subunit to inhibit peptidyl transferase activity and they interfere with the translocation of amino acids during translation and the assembly of proteins (DrugBank, 2005). This prevents regular bacterial growth. These antibiotics improve symptoms in one to three days. It is important to take antibiotics as prescribed by the doctor to completely eliminate the infection and prevent its reoccurrence. One limitation with using antibiotics is that it can be ineffective towards antibiotic resistant bacteria. Furthermore, pneumonia caused by a virus is treated with antiviral drugs such as oseltamivir (National Heart, Lung, and Blood Institute, 2016). Oseltamivir inhibits influenza virus neuraminidase by altering virus particle aggregation and release (DrugBank, 2005). This drug improves symptoms within one to three weeks. |
| ====Medical Procedures==== | ====Medical Procedures==== | ||
| + | In very serious cases, oxygen therapy may be used to facilitate breathing with a non-invasive ventilation or invasive ventilation. A non-invasive ventilator provides oxygen support to a patient through a tightly fitted facial or nasal mask to improve breathing. A study tested the effectiveness of noninvasive ventilation in treating pneumonia. It concluded that the use of ventilation significantly reduced respiratory rate and the duration of stay in the intensive care unit (ICU) (Confalonieri et al., 1999). Some side effects with this therapy include dry or bloody nose, tiredness and morning headaches (Zhang et al., 2012). Whereas, an invasive ventilator provides oxygen through a tube inserted into the trachea through the mouth or the nose. As compared to the non-invasive ventilation, invasive ventilation has a higher infection risk and increased bleeding. Both ventilation methods provide a larger tidal volume with the same inspiratory effort, thus improving alveolar ventilation and decreasing the work of breathing (Zhang et al., 2012). It allows increased oxygen concentrations in the lungs, which is then delivered to the blood. To complement the oxygen therapy, antibiotics and fluids are delivered intravenously through a drip. | ||
| - | Patients with severe chest pain or severe obstruction of the coronary arteries require more invasive treatment options. Currently, there are numerous surgeries which can be performed to combat CAD. These procedures include: Coronary Artery Bypass Graft Surgery (CABG), and Percutaneous coronary intervention (PCI) (Llyod-Jones et al., 2010). | + | <box 60% round left| > {{:noninvasive.png|}} </box| Figure 10: Non-invasive ventilation. Retrieved from: http://careforyou.com.hk/en/the-role-of-non-invasive-ventilation-in-the-treatment-of-copds> |
| - | <box 26% round left| > {{:ang1.jpeg|}} </box| Figure 11: Coronary Artery Bypass Graft Surgery (CABG) performed using the saphenous vein from the leg to bypass blockage in the right coronary artery. Retrieved from: http://umm.edu/health/medical/ency/presentations/heart-bypass-surgery-series> | + | <box 36% round center| > {{:intubation.png|}} </box| Figure 11: Invasive Ventilation (intubation). Retrieved from: https://www.google.ca/search?q=oxygen+therapy&client=safari&rls=en&biw=562&bih=679&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiSm-DP5YbSAhVE5SYKHd9WBsgQ_AUIBigB#tbm=isch&q=ventilator+in+pneumonia&imgrc=RI46QSkVwZ6XRM:> |
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| - | CABG the most common type of heart surgery, is performed to improve blood flow into the heart. As seen in figure 11, this surgery is performed by connecting a healthy artery or vein from another part of your body such as from the leg, chest, or arm to the blocked coronary artery. The healthy artery or vein bypasses the blocked or narrowed part of the artery, thus providing a new pathway for oxygen-rich blood to flow to the heart. During CABG, the breastbone is divided and the heart is stopped to send blood through a heart-lung machine. It is important to note that bypass surgery will not cure coronary artery disease, but it will improve heart function and reduce the risk of dying of heart disease (National Heart, Lung, and Blood Institute, 2016). After the surgery, it is important that the patient takes time to recover. During the recovery period, a patient may participate in a cardiac rehabilitation program under the direct supervision of medical professionals. | + | // |
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| - | As seen in figure 12, PCI, which is also known as coronary angioplasty, is a nonsurgical procedure often used to open blocked or narrow coronary arteries. The procedure requires cardiac catheterization which involves the insertion of a hollow tube (catheter) with a small inflatable balloon at its tip covered with a stent. The inserted balloon catheter then compresses the plaque and opens up the blocked artery. The inserted stent then remains in the artery holding it open (National Heart, Lung, and Blood Institute, 2016). | + | // |
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| - | <box 36% round right| > {{:ang2.jpg|}} </box| Figure 12: Percutaneous coronary intervention (PCI). Retrieved from: http://www.premierheartcarett.com/coronary-angioplasty-pci> | + | \\ |
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| + | ======Future Global Burden====== | ||
| + | As indicated earlier, LTRs were the second highest global burden of disease in 2012 and this number is comprised of many cases of childhood pneumonia. A large scale, systematic literature review conducted in 2013 studied the Global Burden of Childhood Pneumonia and Diarrhea. The results were divided based on global and regional burden and burden by age and number. The authors found incidence and case-related fatality ratios were higher in low and middle income families, suggesting economic status played a large role in disease determinance. As seen in the below figure, younger age groups (0-2 years) currently make up 81% of the youth lives lost to pneumonia. Studies have found that currently, the greatest burden of disease for childhood pneumonia is in Southeast Asia and Africa due to poor hygienic conditions, malnutrition, and sub-optimal breast-feeding (which prevents children from acquiring passive immunity). As of now, 15 developing countries contribute to 64% of total global cases of pneumonia. Lastly, nearly ⅓ severe diarrhoea and pneumonia cases are vaccine-preventable suggesting the need for political and societal intervention. Although the burden of childhood pneumonia is expected to decrease in the future, largely due to increasing awareness and better healthcare facilities, action is required immediately on a global scale to actively reduce the prevalence of this mostly preventable illness. | ||
| + | <box 53% round | > {{:walker.png|}} </box| Figure 12: Global Distribution of cases and of deaths from diarrhea and pneumonia in children aged 0-4 years. (Walker, 2013)> | ||
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| - | ====Life Style Modifications==== | + | // |
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| - | Lifestyle modifications are important for both preventing, and treating CAD. They include: proper nutrition, and regular physical activity. | + | |
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| - | **Nutrition** | + | |
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| - | In general, avoiding a lot of red meat, sugary foods and beverages, and trying to lower your consumption of saturated and trans fat are crucial for reducing your risk of CAD. Saturated fat and trans fat, are known to raise blood cholesterol levels and thus it's important to consume more sources of monounsaturated and polyunsaturated fats which are known to help lower blood cholesterol levels. For example, avocados, salmon & trout, nuts and seeds, olive, canola, peanut , tofu are all great sources of monounsaturated and polyunsaturated fats. In addition, limiting the amount of alcohol you consume and quitting smoking, are also essential in reducing your risks of CAD (National Heart, Lung, and Blood Institute, 2016). | + | |
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| - | **Physical Activity** | + | |
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| - | Regular physical activity has been shown to improve symptoms and reduce mortality in patients with CAD. According to a study conducted in 2001, patients in the training group experienced fewer cardiac events and had a lower number of hospital readmissions. The total mortality of patients with CAD was found to be reduced by about 27% and 31%, as a result of the exercise training (Erbs, Linke & Hambrecht, 2006), (Jolliffe, Rees, Taylor, Thompson, Oldridge,& Ebrahim, 2001). | + | |
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| - | ======Future Global Burden====== | + | |
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| - | The global burden of coronary artery disease (CAD) is expected to increase in the future. This is especially true in developing countries due to a large population size, low education level, poor lifestyle choices and poor healthcare facilities. According to the Global Burden of Disease Study, developing countries contributed 3.5 million of the 6.2 million global deaths from CAD in 1990 (Murray and Lopez, 1996). This study estimates that the developing countries will account for 7.8 million of the 11.1 million deaths due to CAD by 2020 (Murray and Lopez, 1996). This study provides evidence for an increased economic burden of CAD from only developing countries and all the countries of the world. | + | |
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| - | <box 80% round| > {{:w13.jpg|}} </box| Figure 13: Global Shift in Burden of CAD (Wang, 2014).> | + | |
| ======References====== | ======References====== | ||
