John D. Lynch

Such as reflux, pulmonary emboli, coexisting intermittent left heart failure, sleep apnea, dry cold air conditioning, and , from the public health POV, air pollution triggering multiple breathing problems for many asthmatics, can be vitally important.

Again , asthma is quite variable , but classically , extrinsic (allergy triggers) & intrinsic ( no triggers identified), frequently not seasonal , cold & foggy weather worsens). A special tag is aspirin ( NSAIDS) sensitive . Intrinsic asthma is usually year round & viral infections triggers. Intravenous , oral & finally , inhaled corticosteroids . Most chronic asthma is in need of chronic inhaled corticosteroids . The inhalation route is where the triggering inflammation exists and the serious side effects of iv or oral corticosteroids is avoided. Reflux and worsening asthma presents as nocturnal coughing .

The inhaled medications may not be reaching the needing bronchial tubes . Corticosteroids ( prednisone) by mouth may be needed. Also , congestive heart failure could simulate your problem & require diagnosis & additional different medications

Possibly or not. Your physician requires more informative history . Were the pneumonias caused by the same organisms ?

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As an older pulmonologist , to answer said question , I have to know smoker of what type of cigarette , and whether Marijuana is inhaled too ? Lung cancer from unfiltered cigarettes was usually bronchogenic , in the larger bronchial tubes. Blood was coughed or coughing increased & or pneumonia or chest pains occurred , especially with deep breathing ( plueritic). Filtered cigarettes cause more peripheral lung cancers , so called adenocarcinomas , often with brain metastasis first .Oat cell carcinoma are the least common but are the most aggressive of all types . Lung cancer is the most common cancer in non smokers too. Screening today requires a non contrast lung CT scan with less than 20 seconds of expanded breath holding . Small lung cancers are coin-sized when thereby discovered & are curable by minimal lung resection . The screening CT isn't inexpensive though , is yearly and discovers benign & often confusing nodules too.

The problem of treating pulmonary edema depends on whether the origin is cardiogenic or not. Cardiogenic pulmonary can be rapidly acute , have different cardiac causes and frequently awakens the patient at night , responds to intravenous diuretics , drugs that lower blood pressure which reduces cardiac ' work' , high concentrated oxygen as pulmonary edema interferes with oxygenating blood . Endotracheal intubation is reserved for patients that fail to respond with diuresis , fatigue due to labored breathing or have renal failure ( usually missed haemodialysis appointment ). Cardiac valvular dysfunction ultimately may need open heart surgery although there are centers that can replace valves ( aortic usually ) in cardiac catheterization laboratories. Non cardiogenic pulmonary edema frequently requires Intensive Care units , airway intubation , prolonged mechanical ventilation , infectious disease specialists for treatment of presumed bacterial sepsis ( bacteremia). If caused by viral infection , treatment is complicated and may require lung biopsy . Blunt thoracic trauma can also cause pulmonary edema (aspiration of gastric contents , fresh and salt H2O drowning , certain cases ( chlorine , nitrogen dioxide , sulphur containing gases, fluorine , gas Warfare cases : Pulmonary edema can be quite complicated!

Pneumothorax can be spontaneous if due to certain underlying lung diseases , often hereditary. Trauma with broken ribs can require airway intubation & prolonged mechanical ventilation. Pneumothoraces can rarely involve both sides or secondary to procedures in hospital . Penetrating trauma as well as blunt requires chest tube insertion . Mechanical ventilation especially of chronic lung diseases , ( emphysemaous ) , can cause tension pneumothoraces which are true emergencies . As usual , " things" can be complicated.

The Pulmonary Function Study seems to be automated - the suggestion of variable effort can be determined by viewing the FVC curves . The causes of restrictive lung disease , obesity and chest wall abnormalities should be known by observing the patient at time of testing . Small airway asthma can restrict lung volumes .

Yes . CPAP would only minimally raise the polluted air pressure

Chest tightness is not likely due to a reexpanded pneumothorax . Chest tightness can be bronchospasm but would cause shortness of breath..Esophageal spasm is unlikely too. Cardiac angina should prompt immediate call to primary care physician .If after office hours go to nearest Emergency Center or if primary care is not quickly responsive .

Sickle cell anemia could cause chest pain by several mechanisms . The negative chest X-ray excludes the potentially lethal pulmonary crisis . Not all Sickle cell anemias are as severe either. Is bone ( rib) pain due to mild Sickle anemia crisis happening? No risk factors for pulmonary embolism or premature coronary artery are given , although Sickle cell crisis could effect heart & lungs . Three day survival is good news .

Winter in cold climates has almost no environmental allergens. If the symptoms are worse at night , corticosteroids are indicated , & indicated as symptoms stand now.

Hydration , avoid cough suppression. Chest physiotherapy , exclude onset of asthma .

Outpatient vrs. inpatient? Pleurisy , hypoxia , rigors , aspiration , hospital acquired or community?

Deltona the infectious agent.

Respiratory rehab , pursed Lip breathing , O2 at night or with exercise , influenza vax ,pneumonics , exclude sleep apnea .

Smoker or not , chronic bronchitis, Pulmonary embolism, rarer pulmonary conditions .

Smoking cessation.

Antibiotics for bronchitis contributed to antibiotic residty.