What is pneumonia? How does it affect cancer patients?

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A disease of the lungs and respiratory system in which the alveoli (air sacs) become inflamed, infected, or blocked and cannot exchange air (oxygen).
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Related conditions: Aspiration pneumonia, atypical pneumonia, viral pneumonia, walking pneumonia, Legionella pneumonia, pneumocystis carinii pneumonia (PCP), other pneumonia, primary lung cancer, metastatic lung disease

Definition: Pneumonia is a disease of the lungs and respiratory system in which the alveoli (air sacs) become inflamed, infected, or blocked and cannot exchange air (oxygen).

Risk factors: People with respiratory problems tend to be more prone to pneumonia. The elderly, children, and people with complicating health problems are more affected by pneumonia. Pneumonia usually follows a cold or case of the flu. Persons with compromised immune systems such as acquired immunodeficiency syndrome (AIDS) patients, organ transplant patients, and cancer patients are at risk.

Another risk factor is smoking, as this can damage the cilia (microscopic hairs) that naturally sweep impurities out of the lungs. Smoke can paralyze the cilia, allowing secretions to accumulate in the lungs. If these secretions contain bacteria, pneumonia can result.

Exposure to chemicals or other pollutants on the job or in the environment can cause inflammation in the lungs, making it harder to clear the lungs of secretions. People in hospital intensive care units may be exposed to bacteria in the breathing tube of a mechanical ventilator.

Sometimes a tumor will restrict or block a cancer patient’s airways, which results in the inability to clear secretions from the lungs. This can predispose the patient to pneumonia. Other risk factors for the cancer patient include radiation therapy, chemotherapy, steroids, malnutrition, surgery, neutropenia (depressed white cell count), limited mobility, antibiotics, and spleenectomy, which results in immune-system problems.

Etiology and the disease process: Pneumonia can be caused by bacteria, fungi, viruses, or chemical and physical damage such as inhalation of toxins and cancer. When a person breathes, the air passes through the trachea (windpipe) to the lungs, which branch into tubes called bronchi. The bronchi divide into smaller narrow tubes called brochioles that lead to small saclike alveoli (air sacs). The function of the alveoli is to exchange gases (oxygen and carbon dioxide) with the blood capillaries. In pneumonia, these alveoli become inflamed or blocked so that the exchange of oxygen and carbon dioxide is diminished. How severely this exchange is restricted depends on the underlying cause of the pneumonia and the overall health of the patient.

Incidence: An estimated 4 million Americans develop pneumonia each year. Pneumonia and influenza (together) are the eighth leading cause of death in the United States. In 2011, pneumonia claimed 52,294 lives. About 50 percent of all pneumonia is caused by respiratory viruses. Streptococcus pneumoniae (pneumococcus) is the most common pneumonia-causing bacterium.

Symptoms: When people have bacterial pneumonia, they experience difficulty breathing, have shallow rapid breathing, and may have a productive cough. Their cough may produce greenish or yellow sputum (phlegm) or sometimes blood-tinged sputum. Patients with bacterial infections usually experience shaking, chills with fever, and sharp pain in the chest that gets worse when coughing or breathing deeply. Patients with viral pneumonia exhibit more flulike symptoms such as a dry cough, headache, muscle pain, fever, and fatigue. The cough may produce a small amount of clear or white sputum. Viral pneumonia can become bacterial pneumonia (a secondary infection) under the right conditions. Other symptoms include headache, loss of appetite, severe fatigue, sweating and clammy skin, and sometimes mental confusion in older adults.

Screening and diagnosis: Diagnosis is made by physical examination and by listening to the sound of the breath (such as crackles) through a stethoscope. The health care provider usually orders a chest x-ray and reviews the scan for consolidations (white or opaque areas) that represent infected or blocked areas. Sometimes the pneumonia is not easy to visualize with an x-ray, so computed tomography (CT) may be used. Other procedures that may be used to diagnose pneumonia include pulse oximetry and a Pleural fluid culture.

The health care provider may request a culture of the sputum (Gram-staining procedure) to isolate the causal bacteria and confirm that the bacteria are sensitive to the prescribed antibiotic. A complete blood count test will allow the provider to monitor elevated white cell counts that can indicate bacterial disease. Blood tests for specific organisms may be needed to further define the cause of the pneumonia. In severe cases, arterial blood gases may be used to assess oxygenation of the blood.

The diagnostic health care provider may also use a bronchoscope (flexible tube) to examine the lungs for swelling, inflammation, obstruction, or a tumor if the pneumonia is severe and not responding to treatment.

Treatment and therapy: Pneumonia is treated based on the cause of the disease. Antibiotics are used to treat bacterial pneumonia but are useless for viral pneumonia. Strains of bacteria that are resistant to antibiotics are making the treatment of pneumonia a challenge. Most people can be treated at home unless they have underlying chronic diseases such as cancer or are elderly or very young. In these cases, hospitalization is necessary to stabilize the person with intravenous antibiotics and fluids, and possibly oxygen therapy. Occasionally steroid drugs must be used to decrease inflammation or wheezing.

If a patient is allowed to recuperate at home, the health care provider will encourage increased fluid intake to loosen the lung secretions and allow the patient to expectorate (spit out) phlegm. Key to recovery is rest and symptom control, such as managing fever with acetaminophen or aspirin (no aspirin in children).

Sometimes postural drainage will be ordered for patients who need help removing phlegm. With assistance, the patient will lean over the side of the bed with head down and allow gravity to drain the lungs. Those assisting can gently but firmly pound the patient’s upper back to mechanically dislodge mucus. This can be done for about five to fifteen minutes, three times a day, or as tolerated by patients.

Treatment for cancer patients with pneumonia must be aggressive and prompt. Bed rest and taking medications to expel phlegm to clear the airways may be prescribed. The health care provider must choose treatment approaches that complement the therapy that patients are receiving for their cancer so as not to decrease the immune response.

Alternative or complementary treatments offer no cure for pneumonia but may provide some symptom relief. Acupuncture can be used to relieve congestion and may improve generalized fatigue. Some people benefit from a warm bath or room vaporizer using either plain, distilled water or distilled water with essential oils like eucalyptus added. People with asthma should avoid heat inhalations as these can irritate sensitive lung tissue.

Other complementary treatments include massaging the upper back, taking homemade cough syrup of honey and other natural ingredients, and drinking echinacea herbal tea. Supplements such as zinc or vitamins A, C, and E may support the immune sytem.

Prognosis, prevention, and outcomes: Pneumonia can range in severity from mild to severe to fatal, depending on the cause and the age and health of patients. With adequate treatment of the cause, most pneumonia patients will show improvement within about two weeks. If patients have other compromising diseases, such as cancer, recovery may be slower. If patients fail to respond to treatment, they may die of respiratory failure.

Prevention is especially important for patients with cancer or infected with the human immunodeficiency virus (HIV). Measures to prevent infection include frequent washing of hands after blowing the nose or coughing, going to the bathroom, diapering a baby, and before and after food preparation. Immune-compromised people should avoid contact with anyone who has a cold or flu or has been exposed to these illnesses. They should also use a protective mask when cleaning to decrease exposure to dust and molds. The influenza and pneumonia vaccines may also be options and should be checked out with a health care provider.

Bibliography

Baez-Escudero, José L., et al. “Pneumocystis Carinii Pneumonia in Cancer Patients.” Abstracts in Hematology and Oncology 7.1 (2005). Print.

Cunha, Burke A., ed. Pneumonia Essentials. Royal Oak: Physicians’, 2007. Print.

Fein, Alan, et al. Diagnosis and Management of Pneumonia and Other Respiratory Infections. Caddo: Professional Communications, 1999. Print.

File, Thomas. Community-Acquired Pneumonia: Controversies and Questions. Philadelphia: Elsevier, 2013. Print.

Hasleton, Philip S. Spencer’s Pathology of the Lung. Cambridge: Cambridge UP, 2013. Print.

Lechner, Andrew J., George M. Matuschak, and David S. Brink. Respiratory: An Integrated Approach to Disease. New York: McGraw-Hill, 2012. Print.

Terry, Peter B. Lung Disorders: Your Annual Guide to Prevention, Diagnosis and Treatment. Baltimore: Johns Hopkins, 2013. Print.

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