Acute Bronchitis

Acute bronchitis is an infection of the bronchial (say: brawn-kee-ull) tree. The bronchial tree is made up of the tubes that carry air into your lungs. When these tubes get infected, they swell and mucus (thick fluid) forms inside them. This makes it hard for you to breathe.

Acute bronchitis is bronchitis that lasts a short time (several weeks or less), while chronic bronchitis is bronchitis that is long-lasting or recurring (and is usually caused by constant irritation of the bronchial tree, such as from smoking).

Acute Bronchitis - Cause

Acute bronchitis is usually caused by a virus. It is more common during the winter months and often develops after an upper respiratory illness such as influenza (flu) or a cold caused by a virus such as coronavirus, adenovirus, or a rhinovirus. Respiratory syncytial virus (RSV) may be a cause, especially in adults older than 65. About 10% of the time, acute bronchitis is caused by bacteria.¹
Acute bronchitis can also be caused by exposure to smoke, chemicals, or air pollution, all of which can irritate the bronchial tubes. It can also develop from accidentally inhaling (aspirating) food or vomit.
See a picture of acute bronchitis .

How acute bronchitis is spread

Acute bronchitis is spread when an infected person coughs, sneezes, or talks and liquid droplets containing virus particles or bacteria are released into the air and onto objects. Then you may:

• Breathe air that contains the virus particles or bacteria.
• Touch an object that has been touched by an infected person and then touch your eyes, nose, or mouth without washing your hands.

 

 symptoms of acute bronchitis?

Inflammation of the bronchial tubes narrows the inside opening of the bronchial tubes. Narrowing of the bronchial tubes result in increased resistance, this increase makes it more difficult for air to move to and from the lungs. This can cause wheezing, coughing, and shortness of breath. The cough may consist of sputum due to the secretions from the inflamed cells that line the bronchi. By coughing, the body attempts to expel secretions that clog the bronchial tubes. If these secretions contain certain inflammatory cells, discoloration of the mucus may result often in a green or yellow color. Sometimes the severity of the inflammation may result in some bleeding.
As with any other infection, there may be associated fever, chills, aches, soreness and the general sensation of feeling poorly or malaise.

Physical examination

The health care practitioner may examine of the patient's upper airways to look for signs of ear, nose, or throat infection including redness of the tympanic membranes (ear drums), runny nose, and post nasal drip. Redness of the throat or swelling and pus on the tonsils can help distinguish common cold, tonsillitis, and acute bronchitis symptoms. The neck may be palpated or felt to check for swollen lymph nodes. Listening to the lungs may reveal decreased air entry and wheezing.
A chest X-ray may be considered by the health care practitioner if there is a concern that a pneumonia or infection of lung tissue is present.
Blood tests are usually not helpful; occasionally, cultures of sputum are done if a bacterial pathogen is suspected.
treatments for acute bronchitis

Decreasing inflammation is the goal for treating acute bronchitis.
Albuterol inhalation, either with a hand held device (meter dosed inhaler, MDI) or nebulizer will help dilate the bronchial tubes.
Short-term steroid therapy will help minimize inflammation within the bronchial tubes. Prednisone is a common prescription medication that enhances the anti-inflammatory effects of the steroids produced within the body by the adrenal glands. Topical inhaled steroids may also be of benefit with fewer potential side effects.
It is important to keep the patient comfortable by treating fever with acetaminophen or ibuprofen. Drinking plenty of fluid will keep the patient well hydrated and hydration keeps secretions into the bronchial tubes more liquid and easier to expel.
Antibiotics are not necessarily indicated for the treatment of acute bronchitis. Occasionally they may be prescribed should a bacterial infection be present in addition to the usual virus that causes acute bronchitis. However, most acute bronchitis is caused by viruses and no antibiotics are needed.
Although good hydration will help remove secretions into the bronchi, other treatments (for example, Mucinex, Robitussin and others that contain guaifenesin) can help clear secretions though this is often a highly variable finding.
Cough is a very violent action that results in dynamic collapse of the airways. This collapse results in the walls of the airways banging against one another. This action of cough can cause further inflammation and help perpetuate the problem by sustaining and increasing inflammation. Cough suppression with cough drops or other liquid suppressants (for example, Vicks 44, Halls, and cough syrups that contain dextromethorphan) help to break this vicious cycle. In addition, if the person smokes, they should stop. If the acute bronchitis is being caused by inhaled smoke or chemicals, the patient should be removed from these irritant sources.

The treatment of acute bronchitis is geared toward prevention, control, and relief of symptoms (supportive care). In some cases, the following is all that is needed:

• drink plenty of fluids to maintain proper hydration (avoiding dehydration and humidify air); and
  
• use of acetaminophen and ibuprofen to treat fever and decrease the inflammatory resposne.

The treatments section above covers those actions that can usually be done at home. However, people with medical conditions such as high blood pressure should be careful to choose those products approved for patients with high blood pressure because some cough/cold formulations may further increase a person's blood pressure to elevated or dangerous levels. People with diabetes should also choose cough and cold products that will not affect their blood glucose levels. If individuals are unsure which products are safe, they should contact their primary health care practitioner for advice.
For patients with underlying lung disease such as asthma or COPD, increased use of albuterol or similar inhaled medications may be indicated. However, the health care practitioner should be contacted when a patient considers altering their medication usa

•Pneumonia

Pneumonia is an infection of the lungs that is caused by bacteria, viruses, fungi, or parasites. It is characterized primarily by inflammation of the alveoli in the lungs or by alveoli that are filled with fluid (alveoli are microscopic sacs in the lungs that absorb oxygen). At times a very serious condition, pneumonia can make a person very sick or even cause death. Although the disease can occur in young and healthy people, it is most dangerous for older adults, babies, and people with other diseases or impaired immune systems.

In the United States, more than 3 million people develop pneumonia each year, and about 17% of these receive treatment in a hospital. Most people with pneumonia recover, but about 5% will succumb to the condition.

Causes:

Bacteria are the most common causes of pneumonia. However, pneumonia can also be caused by viruses, fungi, and other agents. It is often impossible to identify the specific culprit.

Many bacteria are grouped into one of two large categories by the laboratory procedure used to look at them under a microscope. The procedure is known as Gram staining. Bacteria are stained with special dyes, then washed in a special solution. The color of the bacteria after washing determines whether they are Gram-negative or Gram-positive. Knowing which group the bacteria belong to helps determine the severity of the disease, and how to treat it. Different bacteria are treated with different drugs.

Gram-Positive Bacteria. These bacteria appear blue on the stain and are the most common organisms that cause pneumonia. They include:

• Streptococcus (S.) pneumoniae (also called pneumococcus), the most common cause of pneumonia. This Gram-positive bacterium causes 20 - 60% of all community-acquired bacterial pneumonia (CAP) in adults. Studies also suggest it causes 13 - 38% of CAP in children.
• Staphylococcus (S.) aureus, the other major Gram-positive bacterium responsible for pneumonia, causes about 2% of CAP and 10 - 15% of hospital-acquired pneumonias. It is the organism most often associated with viral influenza, and can develop about 5 days after the start of flu symptoms. Pneumonia from S. aureus most often occurs in people with weakened immune systems, very young children, hospitalized patients, and drug abusers who use needles. It is uncommon in healthy adults.
• Streptococcus pyogenes or Group A streptococcus.

Gram-Negative Bacteria. These bacteria stain pink. Gram-negative bacteria commonly cause infections in hospitalized or nursing home patients, children with cystic fibrosis, and people with chronic lung conditions.

• Haemophilus (H.) influenzae is the second most common organism causing community-acquired pneumonia, accounting for 3 - 10% of all cases. It generally occurs in patients with chronic lung disease, older people, and alcoholics.
• Klebsiella (K.) pneumoniae may be responsible for pneumonia in alcoholics and other people who are physically debilitated. It is also associated with recent use of very strong antibiotics.
• Pseudomonas (P.) aeruginosa is a major cause of hospital-acquired pneumonia (nosocomial pneumonia). It is a common cause of pneumonia in patients with chronic or severe lung disease.
• Moraxella (M.) catarrhalis is found in everyone's nose and mouth. Experts have identified this bacterium as an uncommon cause of certain pneumonias, particularly in people with lung problems such as asthma or emphysema.
• Neisseria (N.) meningitidis is one of the most common causes of meningitis (central nervous system infection). The organism has also been reported in pneumonia, particularly in epidemics of military recruits.
• Other Gram-negative bacteria that cause pneumonia include E. coli, proteus (found in damaged lung tissue), enterobacter, and acetinobacter.

Atypical Pneumonia

Atypical pneumonias produce mild symptoms and a dry cough. Organisms that cause atypical pneumonias include:

• Mycoplasma (M.) pneumoniae, the most common atypical pneumonia organism. Mycoplasma is a very small bacterium that lacks a cell wall. Pneumonia caused by M. pneumoniae spreads when someone carrying the infection comes in close contact with others for a long period of time. It is most often found in school-aged children and young adults. The condition, commonly called "walking pneumonia," is usually mild.
• Chlamydia (C.) pneumoniae is now thought to cause 10% of all CAP cases. This atypical pneumonia is most common in young adults and children, and is usually mild. It is less common, but usually more severe, in the elderly.
• Legionella pneumophila causes Legionnaires' disease. It is contracted by breathing in drops of contaminated water. Outbreaks are often reported in hotels, cruise ships, and office buildings, where people are exposed to contaminated droplets from cooling towers and evaporative condensers. They have also been reported in people who have been near whirlpools and saunas. Legionella pneumophila is not passed from person to person. Some experts believe the organism causes 29 - 47% of all pneumonia cases.

Legionnaires' disease was first described in 1976 after an outbreak of fatal pneumonia at an American Legion convention. The newly described organism that caused the disease was named Legionella pneumophila, shown in this picture. (Courtesy of the Centers for Disease Control and Prevention.)

 

Viral Pneumonia

A number of viruses can cause pneumonia, either directly or indirectly. They include:

• Influenza (Flu). Pneumonia is a major complication of the flu and can be very serious. Influenza-associated pneumonia is particularly risky for the elderly and people with heart disease. It can develop about 5 days after flu symptoms start. The flu weakens the body's defense systems, making it easier for bacteria to grow in the lungs.
• Respiratory syncytial virus (RSV). Most infants are infected with RSV at some point, but it is most often mild. However, RSV is a major cause of pneumonia in infants, as well as in adults with damaged immune systems. Studies indicate that RSV pneumonia may be more common in adults, especially the elderly, than previously thought.
• Severe acute respiratory syndrome (SARS). SARS is a respiratory infection caused by a coronavirus, which appears to have jumped from animals to humans. The disease was first reported in China in 2003.
• Human parainfluenza virus. This virus is a leading cause of pneumonia and bronchitis in children, the elderly, and patients with damaged immune systems.
• Adenoviruses. Adenoviruses are common and usually are not problematic, although they have been linked to about 10% of childhood pneumonias. Adenovirus 14 has been linked to an outbreak of severe community-acquired pneumonia in the Pacific northwest.
• Herpes viruses. In adults, herpes simplex virus and varicella zoster (the cause of chickenpox) can cause pneumonia in people with impaired immune systems.
• Avian influenza. Type A influenza subtype H5N1 in birds is spreading around the globe. Fortunately, only a few hundred human cases have been identified. Most have resulted from close contact with infected birds. The virus does not seem to spread easily from person to person. All patients diagnosed with "bird flu" show signs of pneumonia, although symptoms may be mild. Oseltamivir (Tamiflu) is the most effective treatment for this type of influenza, which can be fatal.

Aspiration Pneumonia and Anaerobic Bacteria

The mouth contains a mixture of bacteria that is normally harmless. However, if this mixture reaches the lungs, it can cause a serious condition called aspiration pneumonia. This may happen after a head injury or general anesthesia, or when a patient takes drugs or alcohol. In such cases, the gag reflex doesn't work as well as it should, so bacteria can enter the airways. Unlike other organisms that are inhaled, bacteria that cause aspiration pneumonia do not need oxygen to live. These bacteria are called anaerobic bacteria.

Opportunistic Pneumonia

Impaired immunity leaves patients vulnerable to serious, life-threatening pneumonias known as opportunistic pneumonias. They are caused by organisms that are harmless to people with healthy immune systems. Infecting organisms include:

• Pneumocystis carinii, renamed Pneumocystis jiroveci in 2002, is an atypical organism. Originally thought to be protozoa, it is now classified as a fungus. P. jiroveci is very common and generally harmless in people with healthy immune systems. It is the most common cause of pneumonia in AIDS patients.
• Fungi, such as Mycobacterium avium
• Viruses, such as cytomegalovirus (CMV)

CMV (cytomegalovirus)
Click the icon to see an image of CMV.

In addition to AIDS, other conditions put patients at risk for opportunistic pneumonia. They include cancers, such as lymphoma and leukemia. Long-term use of corticosteroids and drugs known as immunosuppressants also increases the risk for these pneumonias.

Occupational and Regional Pneumonias

Exposure to chemicals can also cause inflammation and pneumonia. Where you work and live can put you at higher risk for exposure to pneumonia-causing organisms.

• Workers exposed to cattle, pigs, sheep, and horses are at risk for pneumonia caused by anthrax, brucella, and Coxiella burnetii (which causes Q fever).

Inhalation anthrax
Click the icon to see an image of inhalation anthrax.

• Agricultural and construction workers in the Southwest are at risk for coccidoidomycosis (Valley fever). The disease is caused by the spores of the fungus Coccidioides immitis.
• Those working in Ohio and the Mississippi Valley are at risk for histoplasmosis, a lung disease caused by the fungus Histoplasma capsulatum.

Coccidioidomycosis - chest X-ray
Click the icon to see an image of coccidoidomycosis.

• Workers exposed to pigeons, parrots, parakeets, and turkeys are at risk for psittacosis, a lung disease caused by the bacteria Chlamydia psittaci.
• Hantavirus, a rare virus carried by rodents, causes a dangerous form of lung disease. It does not spread from person to person. Cases have occurred in New Mexico, Arizona, California, Washington, and Mexico.

Hanta virus
Click the icon to see an image of the hantavirus.

Severe Acute Respiratory Syndrome (SARS)

Severe acute respiratory syndrome (SARS) is a contagious respiratory infection. The World Health Organization (WHO) officially identified SARS as a worldwide threat in 2003, and issued an unprecedented travel advisory. It wasn't clear at the time whether SARS would become a global pandemic or settle into a less aggressive pattern. The latter seems to have happened.

As of May 2005, there was no known SARS transmission anywhere in the world, according to the U.S. Centers for Disease Control and Prevention (CDC). The SARS outbreak is a dramatic example of how quickly world travel can spread a disease. According to reports from the CDC and WHO, more than 8,000 people became sick with SARS during the outbreak. Of that group, 774 died. The outbreak is also an example of how quickly a networked health monitoring system can respond to an emerging threat.

Causes And Risk Factors. SARS is a serious form of atypical pneumonia that causes acute respiratory distress and sometimes death. It is caused by a new member of the coronavirus family (the family that includes the virus that causes the common cold). The discovery of the SARS-related virus represents one of the fastest identifications of a new organism in history.

SARS is spread by droplet contact. When someone with SARS coughs or sneezes, infected droplets are sprayed into the air. Like other coronaviruses, the SARS virus may live on hands, tissues, and other surfaces for up to 6 hours in these droplets, and up to 3 hours after the droplets have dried.

While droplet transmission through close contact has been responsible for most cases of SARS, there is evidence that SARS might also spread by infected droplets carried on hands and other objects the droplets touch. Airborne transmission was a real possibility in some cases. The live virus was even found in the stool of people with SARS, where it has been shown to survive for up to 4 days. The virus may also be able to live for months or years when the temperature is below freezing.

The estimated incubation period is 2 - 10 days, although there have been documented cases where the start of illness was considerably faster or slower. People with active symptoms of illness are clearly contagious. It is not known, however, how early people begin to be contagious before symptoms appear, or how long they might be contagious after the symptoms have disappeared.

Prevention. The best way to prevent SARS is to avoid direct contact with people who have SARS until 10 days after their fever and other symptoms are gone. Reduce travel to locations where there is an uncontrolled SARS outbreak. The CDC has identified hand hygiene as the cornerstone of SARS prevention. Wash your hands often with soap and water, or use an alcohol-based instant hand sanitizer. Cover your mouth and nose when sneezing or coughing. Consider respiratory secretions infectious. Clean commonly touched surfaces with an Environmental Protection Agency (EPA)-approved disinfectant. In some situations, masks and goggles may help prevent the spread of airborne or droplet infection. Wear gloves when handling potentially infectious secretions.

Prognosis. The overall worldwide death rate from SARS at the end of the outbreaks was 14 - 15%, although it was up to 50% in infected people over age 65. Many more were sick enough to require breathing assistance from a machine (mechanical ventilation). Others needed to be treated in the intensive care unit (ICU).

Today, intensive public health policies are proving to be effective in controlling outbreaks. Many nations have stopped the epidemic within their own countries. All nations must be vigilant, however, to keep this disease under control.

Complications. Complications from pneumonia can include:

• Heart failure
• Liver failure
• Myelodysplastic syndromes (bone marrow abnormalities leading to anemia, low platelet counts, and low white blood cell counts)
• Respiratory failure

Diagnosing Pneumonia

When diagnosing pneumonia, your doctor will perform a physical examination and check for fever and swollen glands. He or she will also listen to your lungs with a stethoscope. Most bacterial infections and some viruses can be detected in sputum or by blood tests. The buildup of liquid in the lungs can be observed in a chest X-ray or a CT scan.

Treating and Preventing Pneumonia

Pneumonias caused by bacteria can be treated with antibiotics, as can those caused by mycoplasma. It is extremely important to take antibiotics exactly as prescribed by your doctor and for the full course of the medication, even if you are feeling better. There are no cures for most viral infections - they must simply be waited out. Your doctor will advise you on ways to ease the symptoms of viral pneumonia. Fungal infections can be treated with antifungal medications.
There are four ways to prevent pneumonia. The first is to eat plenty of fruits and vegetables, stay physically fit, and get enough sleep. This will keep your immune system strong.
The second is to get vaccinated. There are no vaccines for most types of pneumonia, but the two most common types (influenza virus and pneumococcus) can be prevented with vaccines. Yearly influenza vaccination is being promoted for everyone in Canada. Some provinces provide an influenza vaccine free of charge. A pneumococcal vaccine developed for children to protect against disease caused by Streptococcus pneumoniae is recommended as part of the primary series of immunizations for infants. Also, pneumococcal vaccines are recommended for those over the age of 65, people with chronic heart and lung disease, and those who have had their spleens removed.
The third way to prevent pneumonia is to see your doctor about any cough that's still getting worse after 3 or 4 days. See your doctor immediately if you cough up blood or odd-coloured, foul-smelling sputum. Even if the illness starts as a cold, bacteria can easily cause a secondary infection that could lead to serious pneumonia.
The fourth way to limit the spread of the viruses and bacteria that can cause pneumonia is to wash your hands properly and frequently or use hand sanitizers

•Emphysema

Emphysema is a long-term, progressive disease of the lungs that primarily causes shortness of breath due to over-inflation of the alveoli (air sacs in the lung). In people with emphysema, the lung tissue involved in exchange of gases (oxygen and carbon dioxide) is impaired or destroyed. Emphysema is included in a group of diseases called chronic obstructive pulmonary disease or COPD (pulmonary refers to the lungs). Emphysema is called an obstructive lung disease because airflow on exhalation is slowed or stopped because over-inflated alveoli do not exchange gases when a person breaths due to little or no movement of gases out of the alveoli.

Emphysema changes the anatomy of the lung in several important ways. This is due to in part to the destruction of lung tissue around smaller airways. This tissue normally holds these small airways, called bronchioles, open, allowing air to leave the lungs on exhalation. When this tissue is damaged, these airways collapse, making it difficult for the lungs to empty and the air (gases) becomes trapped in the alveoli.
Normal lung tissue looks like a new sponge. Emphysematous lung looks like an old used sponge, with large holes and a dramatic loss of “springy-ness” or elasticity. When the lung is stretched during inflation (inhalation), the nature of the stretched tissue wants to relax to its resting state. In emphysema, this elastic function is impaired, resulting in air trapping in the lungs. Emphysema destroys this spongy tissue of the lung and also severely affects the small blood vessels (capillaries of the lung) and airways that run throughout the lung. Thus, not only is airflow affected but so is blood flow. This has dramatic impact on the ability for the lung not only to empty its air sacs called alveoli (pleural for alveolus) but also for blood to flow through the lungs to receive oxygen.
COPD as a group of diseases ranks as the fourth leading cause of death in the United States. Unlike heart disease and other more common causes of death, the death rate for COPD appears to be rising

Causes of Emphysema

Most emphysema causes involve repeated breathing in of fumes and other things that irritate and damage the lungs and airways.

 

Specific causes of emphysema can include:

 

• Cigarette smoking
• Pipe, cigar, and other types of tobacco
• Certain fumes or dust
• Genetic factors.
   

Smoking

Cigarette smoking is the most common irritant that causes emphysema. Pipe, cigar, and other types of tobacco smoking can also cause emphysema, especially if the smoke is inhaled.

 

Fumes and Dust

Breathing in other fumes and dusts over a long period of time may also cause the disease. The lungs and airways are highly sensitive to these irritants. They cause the airways to become inflamed, narrowed, and destroy the elastic fibers that allow the lung to stretch, then come back to its resting shape. This makes breathing air in and out of the lungs more difficult.

 

Other things that may irritate the lungs and contribute to emphysema include:

 

• Working around certain kinds of chemicals and breathing in the fumes for many years
• Working in a dusty area over many years
• Heavy exposure to air pollution
• Being around secondhand smoke (smoke in the air from other people smoking cigarettes).
   

Genetic Factors

Genes (tiny bits of information in your body's cells passed on by your parents) may play a role in developing emphysema.

 

In rare cases, emphysema is caused by a gene-related disorder called alpha-1 antitrypsin deficiency. Alpha-1 antitrypsin is a protein in your blood that inactivates destructive proteins in the blood. People with antitrypsin deficiency have low levels of alpha-1 antitrypsin; the imbalance of proteins leads to the destruction of the lungs. If people with this condition smoke, the disease progresses more rapidly.

 

Emphysema Risk Factors

Most people with emphysema are smokers or were smokers in the past. People with a family history of emphysema are more likely to get the disease if they smoke. The chance of developing emphysema is also greater in people who have spent many years in contact with lung irritants such as:

 

• Air pollution
• Chemical fumes, vapors, and dusts usually linked to certain jobs.
   

A person who has had frequent and severe lung infections, especially during childhood, may have a greater chance of developing lung damage that can lead to emphysema. Fortunately, this is much less common today, thanks to antibiotic treatments

 

Symptoms

 

Emphysema Symptoms: Breathlessness Most Common

Shortness of breath is by far the most common of emphysema symptoms. Most people with emphysema first notice something's wrong when they become winded during a previously routine activity. This might be climbing stairs or mowing the lawn.
The shortness of breath in emphysema results from structural changes in the lungs. These occur over years in response to lung damage, usually from smoking:

• The linings between air sacs are destroyed, creating air pockets in the lungs.
• Air is trapped in these air pockets and is difficult to breathe out.
• The lungs slowly enlarge, and breathing takes more effort.

In people with emphysema, the muscles responsible for breathing have to work harder, and tire out sooner. The result is feeling breathless -- at first with activity -- and at rest in advanced emphysema.

Other Emphysema Symptoms

Virtually everyone with emphysema experiences shortness of breath, especially with exertion. Many people with emphysema develop some of the other emphysema symptoms:

• Wheezing: This symptom of emphysema is shared with asthma. Wheezing often improves with inhaled medicines called bronchodilators.
• Cough: A large proportion of people with emphysema experience a cough. Often this is related to smoking. However, cough can persist as one of the symptoms of emphysema after quitting smoking.
• Chest tightness or pain: These may be symptoms of emphysema or of coexisting heart disease. Chest tightness occurs more often with exercise or during periods of breathlessness.

People with emphysema may also face some other less common emphysema symptoms:

• Loss of appetite and weight loss
• Depression
• Poor sleep quality
• Decreased sexual function

These symptoms of emphysema occur more often in its advanced stages.

Symptoms of Emphysema Are Slowly Progressive

Symptoms of emphysema are progressive, meaning they can be expected to get worse over time. The rate at which breathlessness worsens depends mainly on whether someone with emphysema continues to smoke.
The lungs slowly lose function with age, even in nonsmokers. In people with emphysema, smoking accelerates this loss of lung function. If a smoker with emphysema quits, he or she can reduce the rate of decline to that of a nonsmoker.
Most people experience the onset of emphysema slowly and gradually. In smokers who develop emphysema, symptoms usually begin between age 45 and 60.
It's difficult to predict the rate of progression of emphysema symptoms. Much is unknown about why emphysema occurs and in whom.
In some people, emphysema symptoms progress faster than in others. It's believed that genetic factors make some people more vulnerable to developing emphysema. Genetics may also cause some people's emphysema symptoms to progress more rapidly.
The majority of people with emphysema, though, can expect relatively slow progression of emphysema symptoms, provided they quit smoking.

Symptoms of emphysema describe what a person with emphysema feels. Signs of emphysema are what doctors look for to help identify emphysema and its severity. Signs of emphysema include:

• Barrel chest: People with emphysema may have a rib cage that's larger than normal, especially from front to back. This results from the lung expansion in emphysema.
• Clubbing: The tips of the fingers may become rounded, because of low blood oxygen levels in advanced emphysema.
• Pursed-lip breathing: To make breathing easier in severe emphysema, people may breathe rapidly through pursed lips.
• Polycythemia: The body produces an excessive amount of hemoglobin and red blood cells, which carry oxygen in the blood.
• Hypoxemia (hypoxia): Low oxygen levels in the blood, detected on pulse oximetry or arterial blood gas testing.
• Hypercarbia: High levels of carbon dioxide in the blood. This results from an inability to exhale carbon dioxide properly in emphysema.
• Cyanosis: Blue-tinged lips, from low blood oxygen in severe emphysema.
• Malnutrition: Muscles slowly waste away in advanced emphysema.

Most signs of emphysema develop only in its advanced stages, when emphysema symptoms are severe.

Treatments and drugs

emphysema can't be cured, but treatments can help relieve symptoms and slow the progression of the disease.
Medications

• Smoking cessation drugs. Prescription medications, such as bupropion hydrochloride (Zyban) and varenicline (Chantix), can help you quit smoking.
• Bronchodilators. These drugs can help relieve coughing, shortness of breath and trouble breathing by relaxing constricted airways, but they're not as effective in treating emphysema as they are in treating asthma or chronic bronchitis.
• Inhaled steroids. Corticosteroid drugs inhaled as aerosol sprays may help relieve shortness of breath. But prolonged use can weaken your bones and increase your risk of high blood pressure, cataracts and diabetes.
• Antibiotics. If you develop a bacterial infection, like acute bronchitis or pneumonia, antibiotics are appropriate.

Therapy

• Pulmonary rehabilitation. A pulmonary rehabilitation program can teach you breathing exercises and techniques that may help reduce your breathlessness and improve your ability to exercise. You'll also receive advice about proper nutrition. In the early stages of emphysema, many people need to lose weight, while people with late-stage emphysema often need to gain weight.
• Supplemental oxygen. If you have severe emphysema with low blood oxygen levels, using oxygen regularly at home and when you exercise may provide some relief. Many people use oxygen 24 hours a day. It's usually administered via narrow tubing that fits into your nostrils.

Surgery
Depending on the severity of your emphysema, your doctor may suggest one or more different types of surgery, including:

• Lung volume reduction. In this procedure, surgeons remove small wedges of damaged lung tissue. Removing the diseased tissue helps the remaining lung tissue work more efficiently and helps improve breathing.
• Lung transplant. Lung transplantation is an option if you have severe emphysema and other options have failed.

•Asthma

Asthma is a disease affecting the airways that carry air to and from your lungs. People who suffer from this chronic condition (long-lasting or recurrent) are said to be asthmatic.

The inside walls of an asthmatic's airways are swollen or inflamed. This swelling or inflammation makes the airways extremely sensitive to irritations and increases your susceptibility to an allergic reaction.
As inflammation causes the airways to become narrower, less air can pass through them, both to and from the lungs. Symptoms of the narrowing include wheezing (a hissing sound while breathing), chest tightness, breathing problems, and coughing. Asthmatics usually experience these symptoms most frequently during the night and the early morning.

Causes of Asthma

The cause of asthma is not known, but there is evidence that many factors play a part.

• Genetic factors: asthma tends to run in families, and many people with asthma also have other allergic conditions such as rhinitis (inflammation of the nose lining). "Allergy" is a hypersensitivity to some proteins foreign to the body; a small dose of the "allergen" will produce a violent reaction in the person concerned.
• Environmental factors: in wealthy, hygienic Western countries, most babies are not exposed to bacterial infections that "kick start" the immune system in early life and may be important in directing the immune system away from allergic responses. They also grow up in warm, well-furnished, carpeted homes that don't allow much airflow. This encourages the rapid breeding of large numbers of house dust mites in bedding, carpets and furnishings. Many children, instead of playing outside in fresh air, spend most of their time indoors. This further increases dust mite sensitisation. Exposure to tobacco smoke, whether during the mother's pregnancy or in early childhood, predisposes children to developing asthma. It also makes their symptoms more severe. Children can also become sensitised to animals, pollens moulds and dust in the environment if they are genetically predisposed.
• Dietary changes: changes in diet in Western countries, such as a high proportion of processed foods, a higher salt intake, a lower antioxidant intake and a lack of fresh oily fish (lower intake of omega-3 fatty acids) may contribute to the development of asthma.
• Lack of exercise: spending more time inside in front of the television means that children get far less exercise. Reduced exercise may mean less stretching of the airways, and a greater tendency for the muscle in the airway walls to contract abnormally when exposed to minor irritants.
• Occupational exposure: in adults, asthma can develop in response to irritants in the workplace - chemicals, dusts, gases, moulds and pollens. These can be found in industries such as baking, spray painting of cars, woodworking, chemical production, and farming.

the Signs and Symptoms of Asthma


Common signs and symptoms of asthma include:

• Coughing. Coughing from asthma often is worse at night or early in the morning, making it hard to sleep.
• Wheezing. Wheezing is a whistling or squeaky sound that occurs when you breathe.
• Chest tightness. This may feel like something is squeezing or sitting on your chest.
• Shortness of breath. Some people who have asthma say they can't catch their breath or they feel out of breath. You may feel like you can't get air out of your lungs.

Not all people who have asthma have these symptoms. Likewise, having these symptoms doesn't always mean that you have asthma. The best way doctors have to diagnose asthma is to use a lung function test, ask about medical history (including type and frequency of symptoms), and do a physical exam.
The type of asthma symptoms you have, how often they occur, and how severe they are may vary over time. Sometimes your symptoms may just annoy you. Other times, they may be troublesome enough to limit your daily routine.
Severe symptoms can be fatal. Thus, treating symptoms when you first notice them is important, so they don’t become severe.
With proper treatment, most people who have asthma can expect to have few, if any, symptoms either during the day or at night.

Many things can trigger or worsen asthma symptoms. Your doctor will help you find out which things (called triggers) may cause your asthma to flare up if you come in contact with them. Triggers can include:

• Allergens from dust, animal fur, cockroaches, mold, and pollens from trees, grasses, and flowers
• Irritants such as cigarette smoke, air pollution, chemicals or dust in the workplace, compounds in home décor products, and sprays (such as hairspray)
• Medicines such as aspirin or other nonsteroidal anti-inflammatory drugs and nonselective beta-blockers
• Sulfites in foods and drinks
• Viral upper respiratory infections, such as colds
• Physical activity, including exercise

Other health conditions can make asthma harder to manage. Examples of these conditions include a runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea. These conditions should be treated as part of an overall asthma care plan.
Asthma is different for each person. Some of the triggers listed above may not affect you. Other triggers that do affect you might not be on the list. Talk with your doctor about the things that seem to make your asthma worse.



Your primary care doctor will diagnose asthma based on your medical and family histories, a physical exam, and test results.
Your doctor also will figure out the severity of your asthma—that is, whether it's intermittent, mild, moderate, or severe. The treatment your doctor prescribes will depend on the level of severity.
Your doctor may recommend that you see an asthma specialist if:

• You need special tests to help diagnose asthma
• You've had a life-threatening asthma attack
• You need more than one kind of medicine or higher doses of medicine to control your asthma, or if you have overall problems getting your asthma well controlled
• You're thinking about getting allergy treatments

Medical and Family Histories

Your doctor may ask about your family history of asthma and allergies. He or she also may ask whether you have asthma symptoms and when and how often they occur.
Let your doctor know whether your symptoms seem to happen only during certain times of the year or in certain places, or if they get worse at night.
Your doctor also may want to know what factors seem to trigger your symptoms or worsen them. For more information about possible asthma triggers, go to "What Are the Signs and Symptoms of Asthma?"
Your doctor may ask you about related health conditions that can interfere with asthma management. These conditions include a runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea.

Physical Exam

Your doctor will listen to your breathing and look for signs of asthma or allergies. These signs include wheezing, a runny nose or swollen nasal passages, and allergic skin conditions (such as eczema).
Keep in mind that you can still have asthma even if you don't have these signs when your doctor examines you.

Diagnostic Tests

Lung Function Test

Your doctor will use a test called spirometry (spi-ROM-eh-tre) to check how your lungs are working. This test measures how much air you can breathe in and out. It also measures how fast you can blow air out.
Your doctor may give you medicine and then retest you to see whether the results have improved.
If your test results are lower than normal and improve with the medicine, and if your medical history shows a pattern of asthma symptoms, your doctor will likely diagnose you with asthma.

Other Tests

Your doctor may recommend other tests if he or she needs more information to make a diagnosis. Other tests may include:

• Allergy testing to find out which allergens affect you, if any.
• A test to measure how sensitive your airways are. This is called a bronchoprovocation (brong-KO-prav-eh-KA-shun) test. Using spirometry, this test repeatedly measures your lung function during physical activity or after you receive increasing doses of cold air or a special chemical to breathe in.
• A test to show whether you have another condition with symptoms similar to asthma, such as reflux disease, vocal cord dysfunction, or sleep apnea.
• A chest x ray or an EKG (electrocardiogram). These tests will help find out whether a foreign object in your airways or another disease might be causing your symptoms.

Diagnosing Asthma in Young Children

Most children who have asthma develop their first symptoms before 5 years of age. However, asthma in young children (infants to children 5 years old) can be hard to diagnose.
Sometimes it's hard to tell whether a child has asthma or another childhood condition. The symptoms of asthma are similar to the symptoms of other conditions.
Also, many young children who wheeze when they get colds or respiratory infections don't go on to have asthma. A child may wheeze because he or she has small airways that become narrow during colds or respiratory infections. The airways grow as the child grows, so wheezing no longer occurs as the child gets older.
A young child who has frequent wheezing with colds or respiratory infections is more likely to have asthma if:

• One or both parents have asthma
• The child has signs of allergies, including the allergic skin condition eczema
• The child has allergic reactions to pollens or other airborne allergens
• The child wheezes even when he or she doesn't have a cold or other infection

The most certain way to diagnose asthma is with a lung function test, a medical history, and a physical exam. However, it's hard to do lung function tests in children younger than 5 years. Thus, doctors must rely on children's medical histories, signs and symptoms, and physical exams to make a diagnosis.
Doctors also may use a 4–6 week trial of asthma medicines to see how well a child responds.

the most effective asthma treatments for short-term relief and long-term control. Understanding asthma treatments will enable you to work with your asthma doctor to confidently manage your asthma symptoms daily. When you do have an asthma attack or asthma symptoms, it’s important to know when to call your doctor or asthma specialist to prevent an asthma emergency. Be sure to read all the in-depth articles that link to topics within each of the following sections. By doing so, you will gain new insight into asthma and how it’s treated.

Asthma Medications

Asthma medications can save your life -- and let you live an active life in spite of your asthma. There are two basic types of drugs used in asthma treatment:
Steroids and Other Anti-Inflammatory Drugs
Anti-inflammatory drugs, particularly inhaled steroids, are the most important treatment for most people with asthma. These lifesaving medications prevent asthma attacks and work by reducing swelling and mucus production in the airways. As a result, the airways are less sensitive and less likely to react to asthma triggers and cause asthma symptoms.
For in-depth information, see WebMD's article on  Asthma, Steroids, and Other Anti-Inflammatory Drugs .
Bronchodilators and Asthma
Bronchodilators relieve the symptoms of asthma by relaxing the muscles that can tighten around the airways. This helps to open up the airways.
Short-acting bronchodilator inhalers are often referred to as rescue inhalers and are used to quickly relieve the cough , wheeze, chest tightness, and shortness of breath caused by asthma. They may also be used prior to exercise for people with exercise-induced asthma. These should not be used daily in the routine treatment of asthma. If you need to use a short-acting bronchodilator as a rescue inhaler more than twice a week, then your asthma is not optimally controlled. Ask your doctor about improving your asthma controller medication.
Long-acting bronchodilators are used in combination with inhaled steroids for control of asthma symptoms or when someone has ongoing asthma symptoms despite treatment with a daily inhaled steroid. Long-acting bronchodilators are never used alone as long-term therapy for asthma. 
For in-depth information, see WebMD's article on Bronchodilators: Airway Openers .

Asthma Inhalers

Asthma inhalers are the most common and effective way to deliver asthma drugs to the lungs . They are available in different types that require different techniques for use. Some inhalers deliver one medication and others contain two different medications. 
For in-depth information, see WebMD's article on Asthma Inhalers .

Asthma Nebulizer

If you’re having difficulty using small inhalers, your doctor may prescribe an asthma nebulizer , also known as a breathing machine. The asthma nebulizer uses a mouthpiece or mask and is typically used for infants, small children, elderly adults, or anyone who has difficulty using inhalers with spacers. The nebulizer changes asthma medications from a liquid to a mist, so that they can be more easily inhaled into the lungs. This takes a few more minutes of time when compared to inhalers.
For in-depth information, see WebMD's article on Asthma Nebulizer (Breathing Machine) .

Prednisone and Asthma Attacks

If you have a serious asthma attack (exacerbation), your doctor may prescribe a short course of oral corticosteroids. When used orally for less than two weeks, the side effects of corticosteroids are only temporary, but when used for many months, these side effects can be serious and permanent. After the severe symptoms of your asthma attack have been successfully treated and controlled, your doctor will work with you to minimize your need for prednisone in the future. Faithfully taking an inhaled corticosteroid every day is the most commonly successful method to do this.
For in-depth information, see WebMD's article on Prednisone and Asthma.

Talk to Your Asthma Specialist

If you have been diagnosed with asthma but your treatment no longer seems to work, then it’s time to check in with your doctor again. Likewise, if you’ve been diagnosed with asthma and you have symptoms that require you to use your rescue inhaler too frequently, go see your asthma doctor. You may need a change to your asthma medication regimen for better control. Your doctor can determine the problem -- and solution -- so you feel better and breathe right.
While asthma is a common disease, it's also very serious breathing problem that demands a proper medical diagnosis and targeted asthma treatment. Get help for asthma. Talk to your doctor for asthma support and find the right asthma drugs that work best for you.

Stroke

A stroke is a condition where a blood clot or ruptured artery or blood vessel interrupts blood flow to an area of the brain. A lack of oxygen and glucose (sugar) flowing to the brain leads to the death of brain cells and brain damage, often resulting in an impairment in speech, movement, and memory.

The two main types of stroke include ischemic stroke and hemorrhagic stroke. Ischemic stroke accounts for about 75% of all strokes and occurs when a blood clot, or thrombus, forms that blocks blood flow to part of the brain. If a blood clot forms somewhere in the body and breaks off to become free-floating, it is called an embolus. This wandering clot may be carried through the bloodstream to the brain where it can cause ischemic stroke. A hemorrhagic stroke occurs when a blood vessel on the brain's surface ruptures and fills the space between the brain and skull with blood (subarachnoid hemorrhage) or when a defective artery in the brain bursts and fills the surrounding tissue with blood (cerebral hemorrhage). Both result in a lack of blood flow to the brain and a buildup of blood that puts too much pressure on the brain.

The outcome after a stroke depends on where the stroke occurs and how much of the brain is affected. Smaller strokes may result in minor problems, such as weakness in an arm or leg. Larger strokes may lead to paralysis or death. Many stroke patients are left with weakness on one side of the body, difficulty speaking, incontinence, and bladder problems.

Causes of Stroke

An ischemic stroke is the result of blockage in blood flow to the brain caused by a blood clot. The buildup of plaque in the artery wall (atherosclerosis, or "hardening of the arteries") is an underlying cause for many ischemic strokes.
Atherosclerosis is a process in which fatty deposits (plaques) build up inside the blood vessels of the body, particularly in the carotid arteries of the neck, the coronary arteries of the heart, and the arteries of the legs. Atherosclerotic plaques can lead to a stroke by causing blockage of blood flow, or by dislodged plaque material (emboli) that can travel to the brain.
A hemorrhagic stroke is caused by bleeding into the brain (intracerebral hemorrhage) or bleeding around the brain (subarachnoid hemorrhage), which results from the breakage of a blood vessel. Brain hemorrhages may result from uncontrolled high blood pressure, and, in some cases, can be caused by structural problems within the blood vessels (e.g., aneurysms or vascular malformations).
There are numerous risk factors that can cause a stroke.
Factors you can't control are:

• age: The risk of stroke increases with advancing age.
• ethnicity: People of First Nations, African, Hispanic, and South Asian descent have greater rates of high blood pressure and diabetes. These conditions increase the risk of stroke.
• family history: The risk of stroke may be higher if a parent or sibling has had a stroke before the age of 65.
• gender: Men have a higher risk of stroke than women who have not reached menopause.
• prior stroke or transient ischemic attack (TIA): Up to one-third of people who survive a first stroke or TIA will have another stroke within 5 years.

Factors you can control are:

• high blood pressure
• heart disease or atrial fibrillation (irregular heartbeat)
• cigarette smoking
• diabetes
• high cholesterol
• physical inactivity
• high alcohol intake (more than 10 drinks per week for women or more than 15 drinks per week for men)
• stress

Other factors that can lead to a stroke are:

• other medical conditions such as amyloid angiopathy and antiphospholipid antibody syndrome
• use of illicit drugs such as cocaine or LSD
• some medications, such as tamoxifen*, phenylpropanolamine, and thrombolytics

Other factors such as oral contraceptive use, hormone replacement therapy, or pregnancy and childbirth in women with pre-existing medical conditions may increase the risk of stroke in specific cases. Talk to your doctor about risk factors that may be relevant to you and your risk of stroke.

The symptoms of stroke begin suddenly because they are caused by an abrupt interruption of blood flow to an area of the brain. When this happens it only takes a few seconds for that part of the brain to stop functioning

Only a small proportion of strokes produce headache symptoms. However, the sudden onset of a severe headache makes doctors suspect that there is bleeding inside the brain. Because of the high risk of death in these cases, people who come into the emergency room complaining of severe headache are rapidly

screened for the presence of blood in the brain


The severity of stroke symptoms varies depending on the part of the brain that is affected. For instance, strokes that affect areas of the brain which have minimal importance in day to day brain activity typically produce mild or unnoticeable symptoms. By contrast, strokes that affect areas of the brain which have maximal importance in day to day brain activity cause the most debilitating and noticeable symptoms.
For instance strokes affecting one of the smell areas of the brain rarely cause identifiable symptoms. By contrast strokes affecting one of the speech areas of the brain nearly always do.

Treatments and drugs


Emergency treatment for stroke depends on whether you're having an ischemic stroke blocking an artery — the most common kind — or a hemorrhagic stroke involving bleeding into the brain.
Ischemic strokeTo treat an ischemic stroke, doctors must quickly restore blood flow to your brain.
Emergency treatment with medications. Therapy with clot-busting drugs (thrombolytics) must start within 4.5 hours if they are given into the vein — and the sooner, the better. Quick treatment not only improves your chances of survival but also may reduce the complications from your stroke. You may be given:

• Aspirin. Aspirin, an anti-thrombotic drug, is an immediate treatment after an ischemic stroke to reduce the likelihood of having another stroke. Aspirin prevents blood clots from forming. In the emergency room, you may be given a dose of aspirin. The dose may vary, but if you already take a daily aspirin for its blood-thinning effect, you may want to make a note of that on an emergency medical card so doctors will know if you've already taken some aspirin.
  Other blood-thinning drugs, such as heparin, also may be given, but this drug isn't proven to be beneficial in the emergency setting so it's used infrequently. Clopidogrel (Plavix), warfarin (Coumadin), or aspirin in combination with extended release dipyridamole (Aggrenox) may also be used, but these aren't usually used in the emergency room setting.
• Intravenous injection of tissue plasminogen activator (TPA). Some people who are having an ischemic stroke can benefit from an injection of a recombinant tissue plasminogen activator (TPA), also called alteplase, usually given through a vein in the arm. This potent clot-busting drug needs to be given within 4.5 hours after stroke symptoms begin if it's given into the vein. This drug restores blood flow by dissolving the blood clot causing your stroke, and it may help people who have had strokes recover more fully. Your doctor will consider certain risks, such as potential bleeding in the brain, to determine if TPA is the most appropriate treatment for you.

Emergency procedures. Doctors sometimes treat ischemic strokes with procedures that must be performed as soon as possible.

• Medications delivered directly to the brain. Doctors may insert a long, thin tube (catheter) through an artery in your groin and thread it to your brain, and then release TPA directly into the area where the stroke is occurring. The time window for this treatment is somewhat longer than for intravenous TPA but still limited.
• Mechanical clot removal. Doctors may use a catheter to maneuver a tiny device into your brain to physically grab and remove the clot.

Other procedures. To decrease your risk of having another stroke or TIA, your doctor may recommend a procedure to open up an artery that's moderately to severely narrowed by plaque. Doctors sometimes recommend these procedures to prevent a stroke. Options may include:

• Carotid endarterectomy. In a carotid endarterectomy, a surgeon removes fatty deposits (plaques) from your carotid arteries that run along each side of your neck to your brain. In this procedure, your surgeon makes an incision along the front of your neck, opens your carotid artery, and removes fatty deposits (plaques) that block the carotid artery. Your surgeon then repairs the artery with stitches or a patch made with a vein or artificial material (graft). The procedure may reduce your risk of ischemic stroke. However, a carotid endarterectomy also involves risks, especially for people with heart disease or other medical conditions.
• Angioplasty and stents. In an angioplasty, a surgeon inserts a catheter with a mesh tube (stent) and balloon on the tip into an artery in your groin and guides it to the blocked carotid artery in your neck. Your surgeon inflates the balloon in the narrowed artery and inserts a mesh tube (stent) into the opening to keep your artery from becoming narrowed after the procedure.

Hemorrhagic strokeEmergency treatment of hemorrhagic stroke focuses on controlling your bleeding and reducing pressure in your brain. Surgery also may be used to help reduce future risk.
Emergency measures. If you take warfarin (Coumadin) or anti-platelet drugs such as clopidogrel (Plavix) to prevent blood clots, you may be given drugs or transfusions of blood products to counteract their effects. You may also be given drugs to lower pressure in your brain (intracranial pressure), lower your blood pressure or prevent seizures. People having a hemorrhagic stroke can't be given clot-busters such as aspirin and TPA, because these drugs may worsen bleeding.
Once the bleeding in your brain stops, treatment usually involves bed rest and supportive medical care while your body absorbs the blood. Healing is similar to what happens while a bad bruise goes away. If the area of bleeding is large, surgery may be used in certain cases to remove the blood and relieve pressure on the brain.
Surgical blood vessel repair. Surgery may be used to repair certain blood vessel abnormalities associated with hemorrhagic strokes. Your doctor may recommend one of these procedures after a stroke or if you're at high risk of a spontaneous aneurysm or arteriovenous malformation (AVM) rupture:

• Surgical clipping. A surgeon places a tiny clamp at the base of the aneurysm, to stop blood flow to it. This can keep the aneurysm from bursting, or it can prevent re-bleeding of an aneurysm that has recently hemorrhaged.
• Coiling (endovascular embolization). In this procedure, a surgeon inserts a catheter into an artery in your groin and guides it to your brain using X-ray imaging. Your surgeon then guides tiny detachable coils into the aneurysm (aneurysm coiling). The coils fill the aneurysm, which blocks blood flow into the aneurysm and causes the blood to clot.
• Surgical AVM removal. Surgeons may remove a smaller AVM if it's located in an accessible area of your brain, to eliminate the risk of rupture and lower the risk of hemorrhagic stroke. However, it's not always possible to remove an AVM if it's too large or if it's located deep within your brain.

Stroke recovery and rehabilitationFollowing emergency treatment, stroke care focuses on helping you regain your strength, recover as much function as possible and return to independent living. The impact of your stroke depends on the area of the brain involved and the amount of tissue damaged. If your stroke affected the right side of your brain, your movement and sensation on the left side of your body may be affected. If your stroke damaged the brain tissue on the left side of your brain, your movement and sensation on the right side of your body may be affected. Brain damage to the left side of your brain may cause speech and language disorders. In addition, if you've had a stroke, you may have problems with breathing, swallowing, balancing and vision.
Most stroke survivors receive treatment in a rehabilitation program. Your doctor will recommend the most rigorous therapy program you can handle based on your age, overall health and your degree of disability from your stroke. Your doctor will take into consideration your lifestyle, interests and priorities, and availability of family members or other caregivers.
Your rehabilitation program may begin before you leave the hospital. It may continue in a rehabilitation unit of the same hospital, another rehabilitation unit or skilled nursing facility, an outpatient unit, or your home.
Every person's stroke recovery is different. Depending on your condition, your treatment team may include:

• Doctor trained in brain conditions (neurologist)
• Rehabilitation doctor (physiatrist)
• Nurse
• Dietitian
• Physical therapist
• Occupational therapist
• Recreational therapist
• Speech therapist
• Social worker
• Case manager
• Psychologist or psychiatrist
• Chaplain

migraine

A migraine headache can cause intense throbbing or pulsing in one area of the head and is commonly accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can cause significant pain for hours to days and be so severe that all you can think about is finding a dark, quiet place to lie down.
Some migraines are preceded or accompanied by sensory warning symptoms (aura), such as flashes of light, blind spots or tingling in your arm or leg.
Medications can help reduce the frequency and severity of migraines. If treatment hasn't worked for you in the past, talk to your doctor about trying a different migraine headache medication. The right medicines, combined with self-help remedies and lifestyle changes, may make a tremendous difference.


causes migraines
Some people who suffer from migraines can clearly identify triggers or factors that cause the headaches, but many cannot. Potential migraine triggers include:

• Allergies and allergic reactions
  
• Bright lights, loud noises, and certain odors or perfumes
  
• Physical or emotional stress
  
• Changes in sleep patterns or irregular sleep
  
• Smoking or exposure to smoke
  
• Skipping meals or fasting
  
• Alcohol
  
• Menstrual cycle fluctuations, birth control pills, hormone fluctuations during menopause onset
  
• Tension headaches
  
• Foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), monosodium glutamate (MSG), or nitrates (like bacon, hot dogs, and salami)
  
• Other foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products, and fermented or pickled foods.

Triggers do not always cause migraines, and avoiding triggers does not always prevent migraines.


symptoms of migraine

• nausea - you may feel queasy and sick; this may be followed by vomiting
• increased sensitivity - you may have photophobia (sensitivity to light), phonophobia (sensitivity to sound) and/or osmophobia (sensitivity to smells), which is why many people with a migraine want to rest in a quiet, dark room

Other symptoms can also occur during a migraine. These include:

• poor concentration
• sweating
• feeling very hot or very cold
• abdominal pain (which can sometimes cause diarrhoea)
• a frequent need to urinate

Not everyone experiences these symptoms when they have a migraine, and they do not usually all occur at once.
The symptoms accompanying migraine can last anywhere between four hours and three days. They will usually disappear when the headache goes.
You may feel very tired for up to seven days after a migraine attack.

Symptoms of aura

About one third of people with migraines have warning symptoms, known as aura, before the migraine. These include:

• visual problems - you may see flashing lights, zigzag patterns or blind spots
• stiffness or a tingling sensation like pins and needles in your neck, shoulders or limbs
• problems with co-ordination - you may feel disoriented or off balance
• difficulty speaking
• loss of consciousness - this only happens in very rare cases

Aura symptoms typically start between 15 minutes and one hour before the headache begins. Some people
may experience aura with only a mild headache


Tests and diagnosis

 you have typical migraines or a family history of migraine headaches, your doctor will likely diagnose the condition on the basis of your medical history and a physical exam. But if your headaches are unusual, severe or sudden, your doctor may recommend a variety of tests to rule out other possible causes for your pain.

• Computerized tomography (CT). This imaging procedure uses a series of computer-directed X-rays that provides a cross-sectional view of your brain. This helps doctors diagnose tumors, infections and other possible medical problems that may be causing your headaches.
• Magnetic resonance imaging (MRI). MRIs use radio waves and a powerful magnet to produce very detailed cross-sectional views of your brain. MRI scans help doctors diagnose tumors, strokes, aneurysms, neurological diseases and other brain abnormalities. An MRI can also be used to examine the blood vessels that supply the brain.
• Spinal tap (lumbar puncture). If your doctor suspects an underlying condition, such as meningitis — an inflammation of the membranes (meninges) and cerebrospinal fluid surrounding your brain and spinal cord — he or she may recommend a spinal tap (lumbar puncture). In this procedure, a thin needle is inserted between two vertebrae in your lower back to extract a sample of cerebrospinal fluid (CSF) for laboratory analysis.

Medical Treatment

Drug treatment for migraine headaches can relieve the pain and symptoms of a migraine attack and prevent further migraine attacks.

Migraines can be treated with two approaches: abortive and preventive.

Abortive: The goal of abortive therapy is to stop it once it starts. The prescribed medications stop a migraine when you one coming or once it has begun and may be taken as needed. Abortive medications can be administered by self-injection, by mouth, or by nasal spray. These forms of medication are especially useful for people who have nausea or vomiting related to their migraine, and they work quickly.
Abortive treatments include the triptans, which specifically target serotonin. They are all very similar in their action and chemical structure. The triptans are used only to treat headache and do not relieve pain from back problems, arthritis, menstruation, or other conditions. People with certain medical conditions should not take these medications.

• Almotriptan (Axert)

• Eletriptan (Relpax)
• Frovatriptan (Frova)
• Naratriptan (Amerge, Naramig)
• Rizatriptan (Maxalt)
• Sumatriptan (Alsuma, Dosepro, Imitrex, Sumavel, Treximet)
• Zolmitriptan (Zomig)

The following drugs are also used for treatment.

• Acetaminophen -isometheptene-dichloralphenazone (Midrin)
• Dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray)
• Ergotamine tartrate (Cafergot)  
• Over- the-counter medications such as Advil Migraine (containing ibuprofen), Excedrin Migraine (containing aspirin, acetaminophen, caffeine), and Motrin Migraine Pain (containing ibuprofen)

The following drugs are mainly used for nausea related to migraine headaches in addition to migraine treatment: 

• Metoclopramide (Reglan)
• Prochlorperazine (Compazine)
  Promethazine (Phenergan)

Some drugs are used for headache pain but are not specific for migraines. These include analgesics, narcotics, and barbiturates. Since they can be habit forming, they are less desirable than specific headache drugs listed above. These drugs should be used primarily as a "backup" for the occasions when a specific drug does not work.

Preventive: This type of treatment is considered if migraines occur frequently, typically more than one migraine per week, or if migraine symptoms are severe. The goal is to lessen the frequency and severity of the migraine attacks. Medication to prevent a migraine can be taken daily. Preventive treatment medications include the following:

• Medications used to treat high blood pressure: beta-blockers (propranolol (Inderal), timolol), calcium channel blockers (verapamil (Covera))
• Antidepressants : amitriptyline (Elavil), nortriptyline (Pamelor)
• Antiseizure medications: gabapentin (Neurontin), topiramate (Topamax), valproic acid (Depakote)
• Botox

Some nontraditional supplement treatments for migraine prevention include butterbur, coenzyme Q10, and feverfew. Evidence has been inconclusive and studies have produced mixed findings.