Part III. Atypical Pneumonias

Atypical pneumonias are pneumonias caused by organisms other than the so-called typical bacteria, viruses, or fungi. The most common causes are Mycoplasma and Chlamydia—two bacterialike organ­isms.

Mycoplasma pneumoniae is the most common cause of pneumonia in people ages 5 to 35, but it's an uncommon cause in others. Epidemics occur especially in confined groups such as stu­dents, military personnel, and families. The epi­demics tend to spread slowly because the incu­bation period lasts 10 to 14 days. Most commonly, this type of pneumonia strikes in the spring.

Mycoplasmal pneumonia often starts with fatigue, a sore throat, and a dry cough. The symptoms slowly worsen. Attacks of severe coughing may produce sputum. About 10 to 20 percent of people develop a rash. Occasionally, anemia, joint pains, or neurologic problems de­velop. Symptoms often persist for 1 to 2 weeks, fol­lowed by slow improvement. Some people still feel weak and tired after several weeks. Although mycoplasmal pneumonia can be severe, it's usually mild, and most people recover without treatment.

Chlamydia pneumoniae is another common cause of pneumonia in people ages 5 to 35. It also affects some elderly people. The disease is trans­mitted from person to person in tiny airborne droplets spread by coughing. The symptoms are similar to those of mycoplasmal pneumonia. Most people don’t become seriously ill, although 5 to 10 percent of the eldery people who contact the disease die.

Diagnosis of both diseases is made by using blood tests to chesk for antibodies against the suspected organisms and by using chest x-ray.

The antibiotics erythromycin and tetracycline are effective, but the response to treatment is slower in chlamydial pneumonia than in mycoplasmal pneumonia. If treatment is stopped too early, symptoms tend to return.

Notes:

rust-colored ржавого цвета

nausea тошнота

chill озноб, простуда

airborne переносимый по воздуху

droplet капелька

vomiting рвота

fatigue усталость, утомление

tend иметь тенденцию, склонность к чему-либо

rash сыпь

Lung Abscess

A lung abscess is a pus-filled cavity in the lung sur­rounded by inflamed tissue and caused by an infection.

Causes

The usual reason an abscess forms is that bac­teria from the mouth or throat are inhaled into the lungs, causing an infection. The body has many defenses against such infections, so they occur only when these defenses are down - for instance, when a person is unconscious or very drowsy because of sedation, anesthesia, alcohol abuse, or a disease of the nervous system. Often, gum disease is the source of the bacteria, but if inhaled, even normal saliva contains enough bac­teria to cause an infection. In some people, par­ticularly those over age 40, a lung tumor may cause a lung abscess by blocking an airway.

Pneumonia caused by certain bacteria, such as Staphylococcus aureus or Legionella pneumophila, or fungi may lead to a lung abscess. In people with a poorly functioning immune system, less com­mon organisms may be the cause. Rare causes include infected pulmonary emboli and infections that are spread by the bloodstream.

Usually, a person develops only one lung ab­scess, but when more develop, they're typically in the same lung. If an infection reaches the lung through the bloodstream, many scattered ab­scesses may develop. This problem is most com­mon among addicts who inject drugs using un­clean needles.

Eventually, most abscesses rupture into an air­way, producing a lot of sputum that needs to be coughed up. A ruptured abscess also leaves a cav­ity in the lung that's filled with fluid and air. Some­times an abscess ruptures into the pleural space (the space between the membrane layers cover­ing the lungs), filling it with pus, a condition called empyema. Rarely, a large abscess ruptures into a bronchus (a large airway that supplies the lung), and the pus spreads through the lung, causing pneumonia and acute respiratory distress syn­drome. If an abscess destroys a blood vessel wall, serious bleeding may occur.

Symptoms and Diagnosis

The symptoms may start slowly or suddenly. Early symptoms resemble those of pneumonia: fatigue, loss of appetite, sweating, fever, and coughing that brings up sputum. The sputum may be streaked with blood. Often, the sputum smells foul because bacteria from the mouth or throat tend to produce foul odors. The person also may feel chest pain with breathing, especially if the pleura is inflamed.

Doctors can't diagnose a lung abscess based on the pneumonialike symptoms and examination findings alone. However, they do suspect a lung abscess when pneumonialike symptoms develop in people who have certain problems, such as a nervous system disorder, an alcohol or drug abuse problem, or a recent episode of uncon­sciousness for any reason.

Chest x-rays often reveal a lung abscess. How­ever, when an x-ray only suggests an abscess, computed tomography (CT) scanning of the chest is usually needed. Cultures of sputum from the lungs may help identify the organism causing the abscess.

Treatment

Prompt, complete healing of a lung abscess re­quires antibiotics given intravenously or orally. This treatment continues until the symptoms dis­appear and a chest x-ray shows that the abscess has resolved. Such improvement usually takes several weeks or months of antibiotic therapy.

To help drain a lung abscess, a person must cough and receive respiratory therapy.When the cause is thought to be a blocked airway, bronchoscopy is performed to remove the obstruc­tion.

In about 5 percent of cases, the infection doesn't clear up. Occasionally, an abscess can be drained through a tube inserted through the chest wall and into the abscess. More often, in­fected lung tissue may have to be removed. Some­times a whole lung lobe or even an entire lung has to be removed.

The death rate for people with a lung abscess is about 5 percent. The rate is higher when the person is debilitated or has a malfunctioning im­mune system, lung cancer, or a very large abscess.

Notes:

pus-filled содержащий гной

drowsy запаздывающий

abuse злоупотребление; злоупотреблять

scattered разбросанный; разрозненный

addict наркоман

resemble иметь сходство

foul odors загноившийся (зловонный) запах

Pleural Disorders

The pleura is a thin, transparent membrane that covers the lungs and also lines the inside of the chest wall. The surface that covers the lungs lies in close contact with the surface that lines the chest wall. Between the two thin flexible surfaces is a small amount of fluid that lubricates them as they slide smoothly over one another with each breath. Air, blood, fluid, or other material can get between the pleural surfaces, creating a space. If too much material accumulates, one or both lungs may not be able to expand normally with breathing, resulting in the collapse of a lung.

Text A. Pleurisy.

Pleurisy is an inflammation of the pleura.

Pleurisy develops when an agent (usually a vi­rus or bacterium) irritates the pleura, resulting in inflammation. Fluid may accumulate in the pleural space (a condition called pleural effusion), or fluid may not accumulate (a condition called dry pleurisy). After the inflammation subsides, the pleura may return to normal, or adhesions may form that make the pleural layers stick together.

Symptoms and Diagnosis

The most common symptom of pleurisy is chest pain, which usually begins suddenly. The pain var­ies from vague discomfort to an intense stabbing pain. It may be felt only when the person breathes deeply or coughs, or it may be felt continuously but may be worsened by deep breathing and coughing. The pain results from inflammation of the outer pleural layer and is usually felt in the chest wall right over the site of the inflammation.

However, the pain may be felt also or only in the abdomen or neck and shoulder as referred pain.

Breathing may be rapid and shallow because deep breathing induces pain; the muscles on the painful side move less than those on the normal side. If a large amount of fluid accumulates, it may separate the pleural layers, so the chest pain dis­appears. Large amounts of fluid can cause diffi­culty in expanding one or both lungs when breathing, causing respiratory distress.

Pleurisy is often easy for doctors to diagnose because the pain is so distinctive. Using a stetho­scope, a doctor may hear a squeaky rubbing sound, called a pleural rub. Even though a chest x-ray won't show pleurisy, it may reveal a rib frac­ture, evidence of lung disease, or a small collec­tion of fluid in the pleural space.

Treatment

The treatment of pleurisy depends on the par­ticular cause. If the cause is a bacterial infection, for example, antibiotics are prescribed. If the cause is a viral infection, no treatment is needed for the infection. If the cause is an autoimmune disease, treating it often allows the pleurisy to resolve.

Analgesics such as acetaminophen or ibuprofen usually help relieve chest pain regardless of the cause of the pleurisy. Codeine and other nar­cotics are stronger pain relievers, but they tend to suppress coughing, which isn't a good idea because deep breathing and coughing help pre­vent pneumonia. Thus, a person with pleurisy is encouraged to breathe deeply and cough when breathing becomes less painful. Coughing may be less painful if the person or a helper holds a pillow firmly against the part of the chest that hurts. Wrapping the entire chest in wide, nonadhesive elastic bandages helps relieve severe chest pain. However, binding the chest to reduce expansion during breathing increases the risk of pneumonia.

 

Notes:

pleurisy плеврит

vague неопределенный, неясный; нечеткий, бесформенный

stabbing насечка

shallow мелкий

induce вызывать, стимулировать

rub трение, стирание; тереться

resolve разрешать(ся)

suppress подавлять

transparent прозрачный

 

 

Major Causes of Pleurisy

• Pneumonia

• Lung infarction caused by pulmonary embolism

• Cancer

• Tuberculosis

• Rheumatoid arthritis

• Systemic lupus erythematosus

• Infection with parasites, such as amebas

• Pancreatitis

• Injury, such as a rib fracture

• Irritants that reach the pleura from the airways or elsewhere, such as asbestos

• Allergic reactions caused by drugs, such as hydralazine, procainamide, isoniazid, phenytoin, chlorpromazine

Text B. Pneumothorax.

Pneumothorax is a pocket of air between the two layers of pleura.

A pneumothorax may occur for no identifiable reason; doctors call this a spontaneous pneumo­thorax. A pneumothorax may also follow an injury or a medical procedure that introduces air into the pleural space, such as thoracentesis. Ventila­tors can cause pressure damage to the lungs that leads to a pneumothorax - most often in people with severe acute respiratory distress syn­drome who need high-pressure mechanical ventilation to survive.

Normally, the pressure in the pleural space is lower than that inside the lungs. When air enters the pleural space, the pressure in the pleura becomes greater than that in the lungs, and the lung collapses partially or completely. Sometimes most or all of the lung collapses, leading to immediate and severe shortness of breath.

Simple spontaneous pneumothorax is usualy caused when a small weakened area of lung (bulla) ruptures. The condition is most common in tall men under age 40. Most incidents of simple spontaneous pneumothorax aren't caused by exertion. Some occur during diving or high-altitude flying, apparently because of pressure changes in the lungs. Most people recover fully.

Complicated spontaneous pneumothorax occurs in people with extensive lung disease. This type of pneumothorax most often results from the rupture of a bulla in older people who have emphysema. Complicated spontaneous pneumothorax may also occur in people with other lung conditions, such as cystic fibrosis, eosinophilic granuloma, lung abscess, tuberculosis and Pneumocystis carinii pneumonia. Because of the underlyinig lung disease, the symptoms and outcome are generally worse in complicated spontaneous pneumothorax.

Tension pneumothorax is a serious and potentially life-threatening form of pneumothorax. In this condition, the tissues surrounding the area where air is entering the pleural space act as a one-way valve, allowing air to enter but not tc escape. This situation causes such high pressure in the pleural cavity that the lung completely collapses, and the heart and other mediastinal structures are pushed over to the opposite side of the chest. If not relieved quickly, tension pneumothorax can cause death in minutes.

Symptoms and Diagnosis

Symptoms vary greatly depending on how much air enters the pleural space and how much of the lung collapses. They range from a little shortness of breath or chest pain to severe shortness of breath, shock, and life-threatening cardiac arrest. Most often, sharp chest pain and shortness of breath and occasionally a dry hacking cough begin suddenly. Pain may be felt in the shoulder, neck, or abdomen. Symptoms tend to be less severe in a slowly developing pneumothorax than in a rapidly developing one. Except with a very large pneumothorax or a tension pneumothorax, symptoms usually subside as the body adapts to the lung collapse, and the lung slowly begins to reinflate.

A physical examination can usually confirm the diagnosis. Using a stethoscope, a doctor may note that one part of the chest doesn't transmit the normal sounds of breathing. The trachea, the large airway that passes through the front of the neck, may be pushed to one side because of a collapsed lung. A chest x-ray shows the air pocket and the collapsed lung.

Treatment

A small pneumothorax usually requires no treatment. It usually doesn't cause serious breathing problems, and the air is absorbed in a few days. The full absorption of a larger pneu­mothorax may take 2 to 4 weeks; however, the air can be removed more quickly by inserting a chest tube into the pneumothorax. A chest tube is needed if the pneumothorax is large enough to impair breathing. The tube is connected to a water-sealed drainage system or a one-way valve that allows the air to exit without allowing any air to get back in. A suction pump may have to be attached to the tube if air keeps leaking in from an abnormal connection (fistula) between an airway and the pleural space. Occasionally, surgery is necessary. Often the surgery is performed using a thoracoscope inserted through the chest wall and into the pleural space.

A recurring pneumothorax can cause consid­erable disability. For people at high risk - for ex­ample, divers and airplane pilots - surgery is con­sidered after the first episode of pneumothorax. For people who have a pneumothorax that won't heal or a pneumothorax that occurs twice on the same side, surgery is performed to eliminate the cause of the problem. In a complicated sponta­neous pneumothorax with a persistent air leak into the pleural space or with a recurring pneu­mothorax, the underlying lung disease may make surgery hazardous. Often, the pleural space can be sealed by giving doxycycline through a chest tube that's draining air from the space.

In tension pneumothorax, emergency removal of the air may prevent death. Air is immediately suctioned out, using a large syringe attached to a needle inserted into the chest. Then, a tube is inserted separately to drain the air continuously.

Notes:

hazardous опасный, рискованный

hacking отрывистый и сухой (кашель)

tension напряженный (о пневмотораксе)

seal герметически закрывать

Lung Cancer

 

Most lung cancer originates in the cells of the lungs; however, cancer may also spread (metastasize) to the lung from other parts of the body.

Lung cancer is the most common cancer in both men and women. More importantly, it's the most common cause of death from cancer in both men and women.

Causes

Cigarette smoking is the main cause of about 90 percent of lung cancer cases in men and about 70 percent of them in women. Lung cancer has become more common in women because more women are smoking cigarettes. The more cigarettes a person smokes, the greater the risk of lung cancer.

A small proportion of lung cancers (about 10 to 15 percent in men and 5 percent in women) are caused by substances encountered or breathed in at work. Working with asbestos, radiation, ar­senic, chromates, nickel, chloromethyl ethers, mustard gas, and coke-oven emissions has been linked with lung cancer, although usually only in people who also smoke cigarettes. The role of air pollution in causing lung cancer is still uncertain. Exposure to radon gas in homes may be impor­tant in a small number of cases. Occasionally, lung cancers, especially adenocarcinoma and alveolar cell carcinoma develop in people whose lungs have been scarred by other lung diseases, such as tuberculosis and fibrosis.

Types of Lung Cancer

More than 90 percent of lung cancers start in the bronchi (the large airways that supply the lungs): such cancer is called bronchogenic car­cinoma. The types are squamous cell carcinoma, small cell (oat cell) carcinoma, large cell carci­noma, and adenocarcinoma.

Alveolar cell carcinoma originates in the air sacs (alveoli) of the lung. Although this cancer can be a single growth, it often develops in more than one area of the lung at once.

Less common lung tumors are bronchial ade­noma (which may be cancerous or noncancer­ous), chondromatous hamartoma (noncancerous), and sarcoma (cancerous). Lymphoma is a cancer of the lymphatic system. It may start in the lungs or spread to them.

Many cancers that start elsewhere in the body spread to the lungs. Cancers spread to the lungs most commonly from the breast, colon, prostate, kidney, thyroid, stomach, cervix, rectum, testis, bone, and skin.

Symptoms

The symptoms of lung cancer depend on its type, its location, and the way it spreads. Usually, the main symptom is a persistent cough. People with chronic bronchitis who develop lung cancer often notice that their coughing becomes worse, if sputum can be coughed up, it may be streaked with blood. If the cancer grows into underlying blood vessels, it may cause severe bleeding.

The cancer may cause wheezing by narrowing the airway in which or around which, it's growing. Blockage of a bronchus may lead to the collapse of the part of the lung that the bronchus supplies, a condition called atelectasis. Another conse­quence may be pneumonia with coughing, fever, chest pain, and shortness of breath. If the tumor grows into the chest wall, it may produce persis­tent chest pain.

Symptoms that arise later include loss of ap­petite, weight loss, and weakness. Lung cancers often cause fluid accumulations around the lung (pleural effusions) that lead to shortness of breath. If cancer spreads within the lungs, severe shortness of breath, low levels of oxygen in the blood, and heart failure may develop.

The cancer may grow into certain nerves in the neck, causing a droopy eyelid, small pupil, sunken eye, and reduced perspiration on one side of the face - together these symptoms are known as Horners syndrome. Cancers at the top of the lung may grow into the nerves that supply the arm, making the arm painful, numb, and weak. Nerves to the voice box may also be damaged, making the voice hoarse.

A cancer may grow directly into the esophagus, or it may grow near it and put pressure on it, leading to difficulty in swallowing. Occasionally, an abnormal channel (fistula) between the esoph­agus and bronchi develops, causing severe coughing during swallowing because food and fluid enter the lungs.

A lung cancer may grow into the heart, causing abnormal heart rhythms, an enlargement of the heart, or fluid in the pericardial sac surrounding the heart. The cancer may grow into or around the superior vena cava (one of the large veins in the chest). Obstruction of this vein causes blood to back up in other veins of the upper body. The veins on the chest wall enlarge. The face, neck, and upper chest wall—including the breasts – swell and become tinged with purple. The condi­tion also produces shortness of breath, head­ache, distorted vision, dizziness, and drowsiness. These symptoms usually worsen when the per­son bends forward or lies down.

Lung cancer may also spread through the bloodstream to the liver, brain, adrenal glands, and bone. This may occur early in the disease, especially with small cell carcinoma. Symp­toms—such as liver failure, confusion, seizures, and bone pain—may develop before any lung problems become evident, making an early diag­nosis difficult.

Some lung cancers produce effects far from the lungs, such as metabolic, nerve, and muscle dis­orders (paraneoplastic syndromes). These syn­dromes aren't related to the size or location of the lung cancer and don't necessarily indicate that the cancer has spread outside the chest; rather, they are caused by substances secreted by the cancer. These symptoms may be the first sign of cancer or the first indication that, cancer has re­turned after treatment. One example of a paraneoplastic syndrome is the Eaton-Lambert syn­drome, characterized by extreme muscle weak­ness. Another example is the muscle weakness and soreness caused by inflammation (polymyositis), which may be accompanied by skin inflam­mation (dermatomyositis).

Some lung cancers secrete hormones or hormonelike substances, resulting in abnormally high hormone levels. For example, small cell car­cinoma tumors may secrete corticotropin, caus­ing Cushing's syndrome, or antidiuretic hormone, causing water retention and low levels of sodium in the blood. Excessive hormone production can also cause the carcinoid syndrome—flushing, wheezing, diarrhea, and heart valve problems. Squamous cell carcinoma may secrete a hormonelike substance that leads to very high blood levels of calcium. Other hormonal syn­dromes linked to lung cancers include breast en­largement in men (gynecomastia) and an excess of thyroid hormone (hyperthyroidism). Skin changes, including darkening of the skin in the armpit, may also occur. Lung cancer can even change the shape of the fingers and toes and cause changes at the ends of long bones that can be seen on x-rays.

Diagnosis

A doctor explores the possibility of lung cancer when a patient, especially a smoker, has a per­sistent or worsening cough or other lung symp­toms. Sometimes a shadow on a chest x-ray of someone with no symptoms provides the first clue.

A chest x-ray can detect most lung tumors, al­though it may miss small ones. However, an x-ray shows only ashadow in the lung, which isn't proof of cancer. Usually, a microscopic examination of a tissue specimen is needed. Sometimes a sample of coughed-up sputum can provide enough ma­terial for such an examination (called sputum cy­tology). Or bronchoscopya may be performed to obtain tissue. If the cancer is too deep in the lung to be reached with a bronchoscope, a doctor can usually obtain a specimen by inserting a needle through the skin while using computed tomogra­phy (CT) for guidance; this procedure is called a needle biopsy. Sometimes, a specimen can be ob­tained only by a surgical procedure called a thoracotomy.

CT scanning may show small shadows that don't appear on chest x-rays. The CT scans also can reveal whether the lymph nodes are enlarged; however, a biopsy (removal of a specimen for mi­croscopic examination) often is needed to deter­mine if the enlargement results from inflammation or cancer. CT scans of the abdomen or head may show that the cancer has spread to the liver, ad­renal glands, or brain. A bone scan may show that it has spread to the bones. Because small cell carcinoma tends to spread to the bone marrow, a doctor sometimes performs a bone marrow bi­opsy (removal of a specimen for microscopic ex­amination).

Doctors categorize cancers based on how large the tumor is, whether it has spread to nearby lymph nodes, and whether it has spread to distant organs. The different categories are called stages. The stage of a cancer suggests the most appropriate treatment and enables a doctor to estimate the patient's prognosis.

Treatment

Noncancerous bronchial tumors are usually re­moved surgically because they may block the bronchi and may become cancerous over time. Often a doctor can't be sure if a tumor at the edge of the lungs is cancerous until it has been re­moved and examined microscopically.

For cancer other than small cell carcinoma that hasn't spread beyond the lung, surgery is some­times possible. Although 10 to 35 percent of can­cers can be removed surgically, removal doesn't always result in a cure. Among people who have an isolated, slow-growing tumor removed, 25 to 40 percent survive at least 5 years after the diagnosis. Survivors must have regular checkups because lung cancer recurs in 6 to 12 percent of people who have undergone surgery. The percentage is much higher for those who continue to smoke after surgery.

Before surgery a doctor performs pulmonary function tests to determine if the remaining lung can provide enough function. If the test results are poor, surgery may not be possible. The amount of lung to be removed is decided during surgery, with the amount varying from a small part of a lung segment to an entire lung.

Occasionally, cancer that begins elsewhere and spreads to the lungs is removed form the lungs after being removed at the source. This procedure is recommended rarely, and only about 10 percent of people who have it survive 5 years or more.

If cancer has spread beyond the lungs, if the cancer is too close to the trachea, or if the person has other serious conditions (such as severe heart or lung disease), surgery isn’t useful. Radiation therapy may be given to people who can’t undergo surgery because they have another serious disease. In such cases the radiation therapy isn’t intended to cure but to slow the growth of the cancer. Radiation therapy also is useful for controlling bone pain, superior vena cava syndrome, and spinal cord compression. However, the therapy can cause inflammation in the lungs (radiation pneumonitis), which produces coughing shortness of breath, and fever. The symptoms may be relieved with corticosteroids, such as prednisone. For lung cancer other than small cell carcinoma, no chemotherapy regimens are particularly effective.

Because small cell carcinoma of the lung has almost always spread to distant parts of the body by the time of diagnosis, surgery isn’t an option. Instead, the cancer is treated with chemotherapy, sometimes coupled with radiation treatment. In about 25 percent of patient chemothereapy substantially prolonges survival. People with small cell carcinoma of the lung who have been well responding to chemotherapy may benefit from radiation treatment to the head to treat cancer that has spread to the brain.

Many people with lung cancer experience a substantial decreaes in lung function, whether or not they undergo treatment. Oxygen therapy and drugs that widen the airways may ease breathing difficulties. Many people with advanced lung cancer develop such pain and difficulty in breathing that they require large doses of narcotics in the weeks or months before their death. Fortunately, narcotics can help substantially if used in adequate doses.

 

Notes:

oat-cell овсяно-клеточный рак

blockage закупорка, блокировка

effusion выпот

droopy eyelid полуопущенное веко

pupil зрачок

sunken запавший, впалый (о глазах)

armpit подмышка

numb онемелый, неподвижный, беспомощный

beyond за пределами

 

EXERCISES

Exercise 1. Make up sentences of your own using the following words and phrases from the texts “Cough”, “Hemoptysis”, “Respiratory Failure”.

among the most common symptoms, to indicate, to protect against, a mixture of mucus, debris and cells, to be aware of, to make a diagnosis, to play an important role, acute or chronic bronchitis, to check for lung cancer, bleeding, to occur, despite testing, to clear an infection, to be needed to stop (to remove), high-risk procedures, respiratory failure, to result from, lead to smth, congenital disorders, to vary, no matter what the cause of respiratory failure…, to result in, if left untreated…, to be inserted through the nose or mouth and into the trachea, to be severely damaged, to cause many complications.

 

Exercise 2. Study the text “Bronchitis” and say whether these statements are right or wrong. Correct them if they are wrong.

 

1. Bronchitis is an inflammation of the bronchi usually caused by a protozoon.

2. Bronchitis is usually mild in chronically ill people and in the elderly.

3. Infectious bronchitis occurs most often in winter.

4. Bronchitis may be caused by viruses, bacteria, and especially an allergic reaction to a fungus, most commonly Aspergillus fumigatus.

5. Smokers and people who have airway diseases that interfere with clearing inhaled particles from the bronchi may have repeated attacks.

6. Irritative bronchitis may be caused by various kinds of dust, tobacco and chemicals.

7. Infectious bronchitis often starts with symptoms of a common cold: runny nose, chills, muscle aches and sore throat.

8. The start of back and muscle aches usually signals the beginning of bronchitis.

9. The cough may last several days.

10. A diagnosis of bronchitis is usually made on the basis of the symptoms, especially the appearance of runny nose and sore throat.

 

Exercise 3. Summarize the texts to the chapter “Occupational Lung Diseases” using the following introductory expressions.

 

The text from this chapter discusses the problem of…

I’d like to stress the importance of…

In connection with…I’d like to say that…

I’d like to draw your attention to the fact that…

I’m certain that…

To sum it all up…it can be said that…

In conclusion it is necessary to say…

 

Exercise 4. Discuss the meaning of the following special terms.

 

cough, shortness of breath, hemoptysis, cyanosis, respiratory failure, inhalation,

virus, airborne antigens, basophils, eosinophils.

 

Exercise 5. Answer the following questions to the texts from the chapter “Pneumonia”.

1. What condition is pneumonia believed to be?

2. What types of pneumonia do you know?

3. What is pneumonia caused by? Is it a single illness?

4. Who is more susceptible to pneumonia?

5. What are the common symptoms of pneumonia?

6. What is the difference between Pneumococcal Pneumonia and Staphylococcal Pneumonia?

7. What may be done in case of Atypical Pneumonia?

8. What drugs may prevent the onset or progression of pneumonia?

9. What may relieve the attacks of severe coughing?

 

Exercise 6. Read the text, think of this problem and give advice to the smokers. Answer the question at the end of the text.

Make the right decision.

If you smoke and you still don’t believe that there’s a definite link between smoking and bronchial troubles, heart disease and lung cancer, then you are certainly deceiving yourself. No one will accuse you of hypocrisy. Let us just say that you are suffering from a bad case of wishful thinking. This needn’t make you too uncomfortable because you are in a good company. Whenever the subject of smoking and health is raised, the governments of most countries hear no evil, see no evil and smell no evil. Admittedly, a few governments have taken timid measures. In Britain, for instance, cigarette advertising has been banned on television. The conscience of the nation is appeased, while the population continues to puff its way to smoky, cancerous death.

 

Question. Do people in our country warry about their health and keeping fit?

 

Exercise 7. Speak about “Lung Abscess” using the following words and expressions.

 

a pus-filled cavity, usual reason, to be unconscious or very drowsy because of smth., may lead to, poorly functioning immune system, to be spread by the bloodstream, to be common among, to be coughed up, serious bleeding, early symptoms, complete healing, antibiotic therapy, to receive respiratory therapy, death rate, malfunctioning immune system.

 

Exercise 8. Underline the correct word or phrase to complete each sentence.

1. Pleurisy develops when a) an agent irritates the pleura, resulting in inflammation; b) bacteria from the mouth or throat are inhaled into the lungs, causing an infection.

2. The most common symptom of pleurisy is a) coughing that brings up sputum; b) chest pain, which usually begins suddenly.

3. A small pneumothorax usually requires a) treatment in an intensive care unit and oxygen therapy is vital to correct low oxygen levels; b) no treatment and doesn’t cause serious breathing problems.

4. The symptoms of lung cancer depend on a) its type, its location, and the way it spreads; b) especially the appearance of the coughed-up sputum.

5. Lung cancers often cause a) a tightness in the chest, coughing, sneezing, runny nose, and watery eyes; b) fluid accumulations around the lung that lead to shortness of breath.

 

Exercise 9. Speak on the following.

1. The most common symptoms of Respiratory Disorders.

2. Diagnosis and Treatment of Bronchitis.

3. Different Types of Pneumonia.

4. Lung Cancer. Diagnosis and Treatment.

SECTIONS 4.

BLOOD DISORDERS

 

Anemias

Anemias are conditions in which the number of red blood cells or amount of hemoglobin (the protein that carries oxygen) in them is below normal.

Red blood cells contain hemoglobin, which en­ables them to carry oxygen from the lungs and deliver it to all parts of the body. Because anemia reduces the number of red blood cells or the amount of hemoglobin in them, the blood can't carry an adequate supply of oxygen. Symptoms, caused by the inadequate oxygen supply, are var­ied. For example, anemia can cause fatigue, weak­ness, inability to exercise, and light-headedness. If the anemia becomes more severe, it can even lead to a stroke or heart attack.

Simple blood tests can identify anemia. The percentage of red blood cells in the total volume of blood (hematocrit) and the amount of hemo­globin in a blood sample can be determined. These tests are part of the complete blood cell count (CBC).

Anemia may be caused by excessive bleeding, decreased red blood cell production, or increased red blood cell destruction (hemolysis).

Text A. Excessive Bleeding.

Excessive bleeding is the most common cause of anemia. When blood is lost, the body quickly pulls water from tissues outside the bloodstream in an attempt to keep the blood vessels filled. As a result, the blood is diluted and the percentage of red blood cells is reduced. Eventually, in­creased production of red blood cells corrects the anemia. However, the anemia may be severe at first, especially if it develops rapidly from a sud­den loss of blood, such as from an accident, sur­gery, childbirth, or a ruptured blood vessel.

Losing large amounts of blood suddenly can create two problems: blood pressure falls be­cause the amount of fluid left in the blood vessels is insufficient, and the body's oxygen supply de­creases because the number of oxygen-carrying red blood cells has diminished. Either problem may lead to a heart attack, stroke, or death.

Far more common than a sudden loss of blood is chronic (continuous or repeated) bleeding, which may occur in various parts of the body. Bleeding from recurrent nosebleeds and hemor­rhoids is obvious. Chronic bleeding from other common sources—such as ulcers in the stomach and small intestine or polyps and cancers in the large intestine, especially colon cancer—may not be obvious because the amount of blood is small and doesn't appear as red blood in the stool; this type of blood loss is described as occult. Other sources of chronic bleeding include kidney or bladder tumors, which may cause blood to be lost in the urine, and heavy menstrual bleeding.

The anemia caused by bleeding ranges from mild to severe, and symptoms vary accordingly. The anemia may produce no symptoms, or it may produce faintness, dizziness, thirst, sweating, a weak and rapid pulse, and rapid breathing. Diz­ziness when a person sits or stands (orthostatic hypotension) is common. Anemia also can cause severe fatigue, shortness of breath, chest pain, and if severe enough, death.

How rapidly the blood is lost is a major deter­minant in whether symptoms will be mild or se­vere. When the blood loss is rapid—over several hours or less—loss of just a third of the body's blood volume can be fatal. When the blood loss is slower—over several days, weeks, or longer— loss of up to two thirds of the blood volume may cause only fatigue and weakness or no symptoms at all.

Treatment

Treatment depends on how rapidly blood is lost and how severe the anemia is. Transfusion of red blood cells is the only reliable treatment for rapid blood loss or severe anemia. Also, the source of bleeding must be found and the bleed­ing must be stopped. When blood loss is slower or the anemia less severe, the body may produce enough red blood cells to correct the anemia with­out transfusion. Because iron, which is required to produce red blood cells, is lost during bleeding, most people who have anemia need to take iron supplements, usually tablets.

 

Notes:

excessive bleeding attempt large intestine faintness dizziness sweating

чрезмерный кровотечение попытка, пытаться толстый кишечник слабость головокружение потение

 

Common Causes of Anemia