Chest Diseases

Chest Diseases

Chest diseases examine all the mechanisms of the respiratory system, especially the lungs. The lungs form the basis of the respiratory system. The respiratory system is not made up of the lungs alone. The bronchi, pleura, chest wall, and diaphragm are also important components of the respiratory system. Chest diseases is a medical specialty that plans the prevention, diagnosis, and treatment of disorders in all of these mechanisms.

What Are Chest Diseases?

The medical name for chest diseases is pulmonology. A chest diseases specialist is also called a pulmonologist. Chest diseases deal with diseases of the respiratory system. In the chest diseases department, both acute and chronic diseases of the respiratory tract are managed with the aim of improving patients' breathing quality as well as their overall health status.

What Are the Symptoms of Chest Diseases?

Symptoms of chest diseases can be listed as follows.

• Persistent, or chronic, cough: Chronic cough is a cough that lasts longer than eight weeks in adults and longer than four weeks in children. It is the most common symptom of chest diseases. It should be remembered that chronic cough, which indicates a health problem, may not be caused only by chest diseases.
• Shortness of breath: Shortness of breath, or dyspnea, is the feeling of difficulty breathing or not getting enough air. Shortness of breath can occur not only during exertion but also at rest. Like chronic cough, shortness of breath may not be caused only by chest diseases.
• Asthma attacks: Asthma is a lung disease that causes the airways to narrow. It leads to symptoms such as cough, wheezing, or shortness of breath that make breathing difficult. An asthma attack is the sudden onset and rapid progression of these symptoms and signs.
• Chest pain and a feeling of tightness in the chest: Chest pain and a feeling of tightness in the chest are among the important symptoms of chest diseases. However, chest pain can also occur for different reasons.
• Wheezing: This is the sound heard while breathing in and out when the airway is partially blocked or narrowed. This sound is usually more pronounced during exhalation. It may sound like a high-pitched whistle. Wheezing may be caused by an underlying condition such as asthma or COPD, or it may also occur due to dust or the common cold.
• Snoring and daytime fatigue: Fatigue can occur for many reasons. However, feeling an irresistible urge to sleep during the day may indicate an underlying condition. Snoring is also a common condition that can impair sleep quality. It occurs when air cannot easily pass through the nose or mouth. In both cases, it is among the symptoms of sleep apnea.
• Coughing up phlegm: Phlegm is actually mucus, which is part of our immune system. Normally it should be clear, slippery, and gel-like. Changes in the color, consistency, and amount of phlegm may be caused by chest diseases. However, different causes such as infection, allergy, and hormonal problems can also present as coughing up phlegm.
• Coughing up blood: Coughing up blood, also known as hemoptysis, may be caused by a simple condition, but it can also be a sign of life-threatening disorders. Coughing up blood does not mean the same as blood in the saliva due to bleeding in the mouth or nose. The most common causes of bloody phlegm include bronchitis or lung inflammation.
• Night sweats and fever: Night sweats and high fever can be caused by many reasons. However, both symptoms may be signs of infection and tuberculosis.

What Do Chest Diseases Evaluate?

Chest diseases examine all complaints related to the respiratory system under close scrutiny; they are concerned with the diagnosis and follow-up of disruptions occurring throughout the respiratory tract.

Diseases treated by Chest Diseases can be listed as follows:

• Asbestosis: A lung disease seen in people who breathe in asbestos dust for a long time, asbestosis causes fibrosis, or scar tissue formation, in the lungs and makes breathing difficult. It is more commonly due to occupational exposure to asbestos.
• As a situation specific to Türkiye, soil in some regions also contains natural asbestos. In people living in these areas, the risk of asbestosis may also be higher than normal.
• Aspergillosis: This is a group of diseases caused by Aspergillus fungi. Aspergillus fungi are usually found in nature on dead leaves, plants, or in soil. However, although rarely, they can also be found indoors, especially in damp environments. In healthy people, Aspergillus fungi usually do not cause any problems. However, in people with weakened immune systems and those who have previously had lung diseases such as tuberculosis, they can cause serious problems.
• Asthma: This is a condition that causes the airways to swell, narrow, and fill with mucus. Asthma can make breathing difficult and can also lead to other symptoms such as chest tightness, cough, and wheezing. It has trigger-based types such as allergic asthma, cough-variant asthma, exercise-induced asthma, and occupational asthma. It can be diagnosed with tests such as pulmonary function tests, allergy blood tests, and spirometry, which measures how well air flows in the lungs. The best way to keep asthma under control is to avoid known triggers and use medications that keep the airways open.
• Bronchiectasis: This is a condition in which the airways in the lungs widen or form sacs as a result of damage. It can be mild or severe. Some people may not even realize they have bronchiectasis. However, in severe cases, bronchiectasis can cause serious damage to the lungs because of recurrent infections. Depending on the condition of the bronchiectasis, symptoms can be relieved with different medications and treatments.

Bronchiectasis and bronchitis are not the same disorder. Both have similar symptoms such as mucus buildup in the lungs and cough. However, while bronchiectasis causes permanent widening of the airways, bronchitis is a temporary infection that does not cause permanent damage.

• Bronchitis: Bronchitis is the inflammation of the airways leading to the lungs and their filling with mucus. A persistent cough is the most common complaint. Bronchitis itself is not contagious. However, viruses and bacteria that can cause bronchitis, such as the flu, are contagious. In addition to the chest diseases specialist's physical examination, it can be diagnosed with a nasal swab, chest X-ray, blood tests, sputum test, and pulmonary function tests. Acute bronchitis is generally not treated with medications. Since bronchitis is almost never caused by bacteria, antibiotics do not help recovery.
• Chronic Obstructive Pulmonary Disease (COPD):

Chronic obstructive pulmonary disease, or COPD, is a term used for lung and airway diseases that restrict breathing. Chronic obstructive pulmonary disease (COPD) is an irreversible disease. Emphysema and chronic bronchitis are two types of COPD. The most common cause of COPD is smoking. However, smoking is not the only cause. Alpha-1 antitrypsin deficiency, a genetic disorder that causes lung damage, is among the causes of COPD. In addition, passive smoking and exposure to toxins in the air, as well as dust and fumes from work or hobbies, can also cause COPD. COPD can be diagnosed with tests performed by the chest diseases specialist, such as pulmonary function tests, pulse oximetry, which measures the oxygen level in your blood, and arterial blood gas testing. There is no definitive cure for COPD. Treatment is aimed at improving symptoms and reducing exacerbations.

• Pulmonary Embolism (Lung Vessel Obstruction)

It is a life-threatening emergency that mostly occurs when a blood clot that breaks off from deep vein thrombosis in the legs blocks the lung vessels. Symptoms of pulmonary embolism can vary from person to person. Therefore, it can be confused with different disorders. The most common symptoms include sudden shortness of breath (dyspnea), stabbing chest pain that worsens with deep breathing, cough, coughing up blood, and sudden fainting (syncope) due to strain on the right ventricle of the heart. On physical examination, tachycardia (increased heart rate) and tachypnea (increased breathing rate) are most commonly detected. In very severe cases, signs of acute right heart failure such as prominence of the neck veins and shock due to low blood pressure may appear.

In the diagnosis of the disease, first the patient's complaints and risk factors are scored to calculate a "clot probability score." In addition, D-dimer levels, a blood test that reflects the clotting system, are checked. If the blood test is high or suspicion of a clot is already very strong, Computed Tomographic Pulmonary Angiography (contrast-enhanced lung CT) is performed to clearly see the location of the clot. If the patient has kidney failure or a drug allergy, a nuclear medicine test called lung scintigraphy is used.

The basis of pulmonary embolism treatment is blood-thinning medications that prevent the clot from growing. In very severe patients with dangerously low blood pressure and shock, emergency vessel-opening strategies such as diagnosis with a rapid bedside heart ultrasound (echocardiography) and administration of strong intravenous clot-dissolving drugs (thrombolysis), direct catheter-based clot removal from the vessel, or surgical removal may be applied.

• Cystic fibrosis: It is among the most common hereditary diseases. Cystic fibrosis is a systemic disease that affects not only the lungs but also the digestive system and sweat glands. However, it shows its most severe effects in the respiratory tract. The symptoms of cystic fibrosis vary depending on the affected organs and the severity of the disease.
• Interstitial Lung Disease (ILD): Interstitial lung disease (ILD) is a term that covers more than 200 conditions that cause inflammation and scarring in the lungs. Interstitial lung disease makes it difficult to transport oxygen from the lungs to the body. Scarring in the lungs makes breathing difficult and leads to chronic cough. Oxygen deficiency can also cause a constant feeling of fatigue. The symptoms experienced may worsen as the disease progresses. In addition to the chest diseases specialist's physical examination, it is diagnosed with tests such as pulmonary function tests, imaging tests, blood tests, and bronchoscopy. There is no definitive cure for interstitial lung disease. Treatment generally focuses on treating the underlying disease and improving symptoms.
• Lung cancer: It is one of the most common cancers. It occurs as a result of uncontrolled growth of cells in the lungs. Treatments include surgery, chemotherapy, immunotherapy, radiotherapy, and targeted drugs. It usually develops as a result of long-term smoking or exposure to harmful gases. The most common symptoms are a persistent stubborn cough, shortness of breath, and bloody phlegm, and when diagnosed early, treatment success is quite high.
• Pulmonary hypertension: This is high blood pressure in the pulmonary arteries. Chest pain, shortness of breath that worsens over time, dizziness, and swelling of the ankles and abdomen are among the most common symptoms. Most cases of pulmonary hypertension cannot be cured. The main goal of treatment is to relieve symptoms and improve quality of life.
• Sarcoidosis: It is a systemic disease characterized by the formation of small inflammatory foci called granulomas in the lungs, lymph nodes, skin, or other parts of the body. The symptoms of sarcoidosis depend on where the granulomas form in your body. Most people with sarcoidosis have lung symptoms, but symptoms can also appear in the skin, eyes, joints, and almost anywhere in your body. Symptoms include cough, shortness of breath, tender sores on the shin bones, eye pain, and redness. Many cases resolve spontaneously or with treatment, but sometimes it can become a chronic condition.
• Pleural diseases (diseases of the lung lining): The pleura is a large, thin layer of tissue that surrounds the lungs and lines the chest cavity. Pleural diseases are conditions that affect the pleura or the pleural space and lead to infection or inflammation. Diagnosis and treatment of conditions such as inflammation of the pleura (pleurisy), fluid buildup between the pleural layers (pleural effusion), excessive air or gas buildup in the pleural space (pneumothorax), and the presence of a tumor in the pleural space (mesothelioma) are carried out by chest diseases specialists.
• Lung infections: A lung infection occurs when harmful microbes such as viruses, bacteria, or fungi enter the lungs and cause inflammation. These infections can range from a mild common cold to severe pneumonia and tuberculosis that may require medical treatment.
• Sleep apnea: It is a disorder in which breathing repeatedly stops during sleep, seriously affecting quality of life and heart health. The brain tries to wake the person to protect them and ensure they breathe enough. This prevents restful and healthy sleep. It causes symptoms such as frequent waking from sleep at night, pauses in breathing during sleep, unusual breathing patterns, snoring, shortness of breath, and daytime sleepiness. It is diagnosed with the chest diseases specialist's physical examination and a sleep test called polysomnography. Treatment primarily involves using a breathing device such as continuous positive airway pressure (CPAP) or treating the underlying conditions that cause sleep apnea.
• In addition to the diagnosis, treatment, and follow-up of all these diseases, a holistic approach to lung diseases and lung health and close follow-up are provided.
• In addition, diagnosis, treatment, and follow-up are provided for lung problems caused by other diseases and medications used.

What Are the Tests Used in the Treatment of Chest Diseases?

• Complete Blood Count (CBC)

A complete blood count can provide information about the overall health status. In particular, leukocyte, or white blood cell, and CRP values provide information about the level of infection and inflammation.

• Radiological imaging methods

Chest X-ray and computed tomography (CT) are among the most commonly used radiological imaging methods.

• Lung Diffusion Test (DLCO)

It is a type of pulmonary function test that shows how well the lungs work.

• Cardiopulmonary Exercise Test (CPET)

It shows how the heart and lungs respond to exercise.

• Bronchoscopy

It is a minimally invasive procedure used to diagnose problems in the lungs and airways.

• Arterial Blood Gas (ABG)

The oxygen and carbon dioxide levels in the blood are measured using blood taken from an artery.

• EBUS (Endobronchial Ultrasonography)

It is used especially in staging lung cancer and in obtaining tissue samples without surgery for the diagnosis of diseases such as sarcoidosis or tuberculosis that cause enlargement of the lymph nodes in the lungs.

• Pulmonary function tests

Spirometry: It is the most commonly used test in clinics. It measures how much air a patient can exhale through a mouthpiece after a deep breath, and especially how fast and forcefully they can blow it out in the first second. It is the first step in detecting and grading airway obstructions.

Bronchodilator Spirometry (Reversibility Test): After the initial spirometry measurement, the patient inhales a short-acting bronchodilator, and the test is repeated 15-20 minutes later. If an increase is detected in the post-medication assessment, it shows that the narrowing in the airways is reversible. It is used especially to distinguish asthma from COPD.

Measurement of Lung Volumes: It measures the amount of air that remains in the lungs even after the patient's deepest exhalation, as well as the total air capacity the lungs can physically hold, which cannot be measured with standard spirometry. It is usually performed by having the patient sit in a glass cabin. It plays a critical role in diagnosing restrictive diseases such as pulmonary fibrosis, where lung tissue loses its elasticity.

Lung Diffusion Capacity Test: It measures not the mechanical strength of the lungs, but their functionality. It calculates how efficiently oxygen from inhaled air is transferred from the air sacs in the lungs to the blood in the surrounding capillaries. During the test, the patient inhales a very small amount of an harmless gas. They are asked to hold their breath for about 10 seconds. This capacity decreases in conditions such as emphysema, pulmonary embolism, or pulmonary hypertension.

Arterial Blood Gas Analysis: Although it is not a direct exhalation test, it is the laboratory method that most clearly shows the breathing performance of the lungs. Usually with a blood sample taken from the artery in the wrist, the oxygen and carbon dioxide pressures in the blood and the blood's pH (acid-base) balance are directly measured. It is vital in monitoring respiratory failure.

Maximum Voluntary Ventilation: This is based on the patient breathing as fast and deeply as possible for 12 to 15 seconds. It measures the strength of the respiratory muscles, the elasticity of the lungs, and the overall capacity of the respiratory system. It is usually requested before major surgical operations to understand whether the patient can tolerate the surgery.

Provocation Tests: These are used to test airway hyperreactivity in patients who show asthma symptoms but have normal standard spirometry results. The patient inhales a medical agent that mildly narrows the airways in a gradual manner, and the lungs' response is monitored with spirometry.

• Allergy tests

Skin Prick Test: In chest disease practice, it is the most commonly used test, especially to find the real triggers behind allergic asthma and chronic cough complaints. Performed in a hospital setting under specialist supervision, the skin prick test makes it possible to detect many respiratory allergens, from pollens to house dust mites, from pet dander to mold fungi, in as little as 15 to 20 minutes.

How Is the Skin Prick Test Performed?

• A test grid is drawn on the inner part of the forearm or, in pediatric patients, on the back, with at least 2 cm between each point. This distance is critical to prevent the reactions from overlapping.
• One drop of standardized allergen solutions is placed on the designated points. Then, using a sterile fine-tipped device, light pressure is applied without causing the skin to bleed so that the solution seeps just under the skin.
• After waiting about 20 minutes, the results are examined. The appearance of an itchy, red, raised wheal at least 3 mm in diameter in the area where the allergen was placed indicates that the test is positive.

Blood Test (Specific IgE Test): In cases where the skin prick test cannot be performed or is insufficient, Specific IgE tests from blood are used. This method makes it possible to measure in the laboratory the specific antibodies produced by the immune system against respiratory substances such as pollen, house dust mites, or pet dander, which it perceives as threats.

There is no definite positive or negative clinical threshold value valid for every patient in blood tests.

The level of antibodies detected in the blood does not allow prediction of how severe a future asthma or allergy attack in the patient may be.

Checking dozens of allergens at once for general screening when there are no complaints can lead to misleading results.

• Measurement of Lung Cell Damage: Detecting lung cell damage requires monitoring the totality of cellular destruction, repair efforts, and clotting processes. It is not limited to radiological imaging alone; it is a multidimensional monitoring process that starts at the molecular protein level and extends to the tissue's repair genetics.

Measurement of lung cell damage is carried out with the following methods:

• Alveolar Damage Markers: Directly show damage to the alveolar epithelial cells that enable gas exchange.
• Fibrosis and Hardening: It is the most sensitive glycoprotein that measures the fibrotic tendency of lung tissue to become irreversibly hardened.
• Tissue Destruction Enzymes: These are enzymes that break down the supporting tissue of the lung. An increase in their levels indicates active tissue destruction.
• Clotting and Repair: Shows impaired clot-dissolving capacity in the lung vessels and that cells enter the aging phase and stop renewing.
• Volumetric CT Quantification: By analyzing density values on tomography, it calculates as a percentage the ratio of areas that have completely lost function to the total lung volume.
• Monitoring Repair Capacity: By tracking repair signals of Type 2 epithelial cells, which are the stem cells of the lung, it is predicted whether the tissue is repairable.