Anthrax Disease Information

Anthrax is a sometimes deadly infection caused by the bacterium Bacillus anthracis. This bacterium is housed in a spore — a cell that's dormant, but may become active in the right conditions. Anthrax usually affects livestock, but it also infects humans. Humans can become infected when handling products of infected animals, or if exposed to anthrax that's used as a biological weapon — such as when anthrax spores were deliberately spread in powder-containing envelopes through the U.S. postal system in 2001.
Anthrax infection can occur through a wound in the skin, by ingesting it or by inhaling it. Symptoms depend on which way you're infected and range from a sore on the skin to nausea and vomiting to shock. Early treatment with antibiotics can cure most anthrax infections spread through the skin and many of those spread by ingestion. Inhaled anthrax is the most difficult to treat and is often fatal.
Signs and symptoms

Anthrax occurs in three forms, each with different signs and symptoms. Signs and symptoms usually occur within seven days of exposure to the bacterium, but with inhalation anthrax, they can take up to 43 days to appear.
Cutaneous anthrax. This form of anthrax infects the skin. It's contracted by direct contact with the bacterium, when anthrax spores enter a cut, blister or abrasion on your skin. The infection begins as a raised, sometimes itchy bump resembling an insect or spider bite. But within a day or two, the bump develops into an open, usually painless sore with a black center. Cutaneous anthrax is the most common form of the disease, accounting for 95 percent of cases, and it's also the mildest form of the disease. With treatment, cutaneous anthrax is fatal in less than 1 percent of cases. However, there is a slight danger that the infection may spread to other parts of your body. Signs of spreading include fever, chills and swollen, infected lymph glands above the area of the sore.
Gastrointestinal anthrax. It's possible to contract this form of anthrax by eating undercooked meat from an infected animal. Gastrointestinal anthrax causes inflammation of your intestines, and then sores (ulcers) form within your intestines — much like the sores that appear on the skin in the cutaneous form. Initial signs and symptoms include nausea, vomiting, loss of appetite and fever, followed by abdominal pain, vomiting of blood and severe, bloody diarrhea. It's fatal in 25 percent to 60 percent of cases.
Inhalation (pulmonary) anthrax. It's possible to contract this form of anthrax by inhaling anthrax spores. Initial signs and symptoms of inhalation anthrax resemble those of the flu — sore throat, mild fever, fatigue, muscle aches and mild chest discomfort. These first signs and symptoms may last for a few hours or a few days, and they may appear to subside briefly. However, soon afterwards, the disease progresses, producing a high fever, breathing problems and shock. The disease affects lymph nodes inside the chest, may destroy lung tissue, and may spread to the blood or to the brain, causing meningitis. Researchers believe that inhalation anthrax is fatal in approximately 75 percent of cases, even with appropriate treatment. However, of the 11 people infected with inhalation anthrax in the United States in 2001, six survived.
Causes

Anthrax disease is caused by a rod-shaped bacterium, Bacillus anthracis, which normally resides as a spore in the soil. These spores are extremely hardy and have been known to survive in soil for many years. Anthrax spores remain dormant until they find their way into a host — an animal or a human.

Anthrax primarily affects wild and domestic livestock — such as sheep, cattle, horses, goats and camels — that contract intestinal anthrax by eating spores from the soil. Anthrax once was common in most areas where livestock are raised. But in modern times, animal vaccination programs have greatly reduced the natural occurrence of the disease among both animals and humans in much of the world.

Outbreaks of animal anthrax still occur in places that don't have widespread livestock immunization programs, such as Iran, Iraq, Turkey, Pakistan and sub-Saharan Africa. Although rare, they occasionally occur in the United States, as well.

Historically, most human cases of anthrax have occurred as a result of exposure to infected animals or their meat or hides. In fact, anthrax used to be known as woolsorter's disease because people who worked with wool in the 18th century often contracted inhalation anthrax from handling spore-contaminated wool in enclosed factories.

Anthrax as a biological weapon
Before 2001, numerous nations are believed to have experimented with anthrax as a biological weapon, including the United States. The worst documented outbreak of inhalation anthrax in humans occurred in Russia in 1979, when anthrax spores were accidentally released from a military biological weapons facility near the town of Sverdlovsk, killing at least 66 people.

But most people weren't aware of this weapon until the fall of 2001, when letters containing anthrax spores sent via the U.S. Postal Service resulted in 22 cases of anthrax infection. Eleven people were infected with cutaneous anthrax. Eleven others were infected with inhalation anthrax, resulting in five deaths.

These cases heightened concern about the possibility of a large-scale anthrax attack by terrorist groups. The Centers for Disease Control and Prevention has classified anthrax as a Category A bioterrorism agent — which is considered the biggest threat to national security. Unlike some other Category A agents, anthrax doesn't spread person to person, thus limiting the risk to those directly exposed in an attack.
Risk factors

Anthrax isn't contagious. People who get inhalation anthrax don't exhale spores. There are no reports of the disease spreading from one person to another.

To contract anthrax, you must come in direct contact with anthrax spores. However, you can be exposed to anthrax spores and not become infected.
When to seek medical advice

If you believe that you're at risk of anthrax exposure — for example, you work in an environment where anthrax has been detected — immediately notify authorities for testing and see a doctor for evaluation and care. If you develop signs and symptoms of the disorder after exposure to animals or animal products in parts of the world where anthrax exists, seek prompt medical attention. Early diagnosis and treatment is crucial.
Screening and diagnosis

In the United States, the Laboratory Response Network (LRN) — a partnership linking 100 state and local public health laboratories — has been established to quickly diagnose and stop the spread of anthrax.

If authorities suspect exposure to anthrax, environmental sampling can help determine whether a substance contains anthrax spores or whether an area — such as a mailroom, desk, ventilation system or animal source — may be contaminated.

In addition, various tests can help doctors determine if a person has the disease.

Environmental sampling
If you find a suspicious powder that you think may contain anthrax, immediately contact local law enforcement authorities. They can decide to bring in a hazardous-material team trained to test for materials such as anthrax. The team collects samples of the substance and samples from surfaces that may have been contaminated. The samples are then checked in a lab for signs of Bacillus anthracis bacteria.

If anthrax is found in the environment, the contaminated areas — such as a mailroom, desk or ventilation system — are sterilized with special washes.

Human tests
In addition to examining you and inquiring about your health status and where you work, your doctor can administer tests that may determine if you have the disease. However, there's no screening test that can show if you've been exposed to anthrax.

Your doctor will want to rule out other, much more common conditions that may be causing your signs and symptoms, such as flu (influenza) or pneumonia. You may have a rapid flu test to quickly diagnose a case of influenza.

Tests to detect and diagnose anthrax include:
Skin biopsy. A sample of a suspicious lesion on your skin can be sent to a lab to check for microscopic evidence of cutaneous anthrax.
Sputum testing. To diagnose inhalation anthrax, respiratory secretions can be cultured to check for the presence of anthrax bacteria.
Blood tests. If you have signs and symptoms of any form of anthrax, your doctor can take a blood sample and send it to a lab, where it can be checked for the presence of anthrax bacteria. The bacteria should grow in cultures within six to 24 hours, but a laboratory in the LRN must confirm any diagnosis.
Chest X-ray or computerized tomography (CT) scan. Your doctor may request a chest X-ray or CT scan to help diagnose inhalation anthrax. Since this form of anthrax infects both the lungs and lymph nodes in your chest, there's often a very characteristic appearance on the chest X-ray.
Endoscopy and stool samples. To diagnose intestinal anthrax, your doctor may examine your throat or intestines with the aid of an endoscope — a thin, flexible tube with a video camera at its tip that can be inserted into your throat or intestines to check for anthrax lesions. Stool samples can be tested for the presence of anthrax bacteria.
Spinal tap. Sometimes your doctor may need a sample of spinal fluid to confirm a diagnosis of anthrax meningitis. This involves inserting a needle into your spinal canal and drawing out fluid for testing.
If a case of anthrax is suspected or confirmed, doctors have been advised to contact local and state health officials immediately. This helps alert government and health leaders — and the public — of a possible outbreak.
Treatment

Treatment for all three forms of anthrax depends on oral or intravenous (IV) antibiotics. Treatment is most effective when started as early as possible.

Some strains of anthrax may be more responsive to one type of antibiotic than to another. Ciprofloxacin (Cipro), doxycycline and penicillin are approved by the Food and Drug Administration (FDA) for treatment of anthrax in adults and children. However, your doctor may prescribe other antibiotics or a combination of antibiotics.

These medications work by killing the anthrax bacteria. However, antibiotics may fail in inhalation anthrax once symptoms become severe because the bacteria may already have released large amounts of toxin that aren't affected by antibiotics. Scientists are working to develop an anthrax antitoxin that could neutralize the toxin produced by anthrax bacteria.

If you've been exposed to anthrax, your doctor will likely prescribe a long course — 60 days or more — of antibiotics. If you have inhalation anthrax, you'll likely be hospitalized and treated with intravenous antibiotics.

Anthrax isn't spread person to person. So a person with anthrax doesn't have to be quarantined or isolated. If you were in contact with someone with anthrax, you'll need to be treated only if you were exposed to a source of anthrax infection.
Prevention

In addition to treating anthrax, antibiotics are recommended to prevent infection in anyone exposed to anthrax. Ciprofloxacin and doxycycline are FDA-approved for post-exposure prevention of anthrax in adults and children. Levofloxacin is approved for adults who've been exposed.

Anthrax vaccine
The FDA approved a human vaccine in 1970, which has mostly been used by military personnel. Vaccination consists of three shots given two weeks apart followed by three additional shots given at six, 12, and 18 months. Annual booster shots are recommended to maintain immunity.

The human anthrax vaccine doesn't contain live anthrax bacteria, so it can't cause the infection. Side effects may include soreness at the injection site, a flu-like reaction and possibly more-serious allergic reactions. The anthrax vaccine isn't recommended for children, pregnant women or older adults. It's an effective, but not a 100 percent protective vaccine.

The vaccine isn't available to the public. Instead, the vaccine is reserved for:
Active-duty U.S. military personnel who are deployed to areas with high risk of exposure to anthrax
People who work with anthrax in a laboratory setting
People who handle potentially infected animal products in areas of the world where anthrax is a threat to livestock
People who work with imported animal hides or furs from areas with a high incidence of anthrax

Scientists are working to produce a new anthrax vaccine. The new vaccine may require fewer doses and be available in large quantities.

Avoiding contact with infected animals
In countries where anthrax is common and vaccination levels of animal herds are low, it's wise to avoid contact with livestock and animal products and to avoid eating meat that hasn't been properly slaughtered and cooked.

Other preventive measures include carefully handling dead animals suspected of having the disease and providing good protection when processing hides, fur, wool or hair.
Coping skills

When it comes preparing for a possible anthrax attack, the most prudent course of action is to keep a healthy perspective and to stay aware of current events. Here are some things you can do and not do to protect yourself and your family from anthrax:

Should you call your doctor and ask to be vaccinated against anthrax? No. The anthrax vaccine isn't available to the public at this time.

Should you call your doctor and ask for a prescription for antibiotics? No. Only people who have been exposed to anthrax should take the antibiotics, and health officials must determine who has been exposed. In addition, there's no way to know which antibiotic is appropriate to take until exposure or an outbreak occurs. Ciprofloxacin and other antibiotics should be used only when there's a medical need as determined by a doctor.

The anthrax attacks in the United States after Sept. 11, 2001, increased public awareness of the risk of anthrax and other bioterrorism agents. U.S. government and health officials are on alert for outbreaks of anthrax and have plans in place to address potential large-scale outbreaks.

To reduce your exposure to anthrax used as a biological weapon, report any suspicious substance to local authorities. If you come in contact with a clearly suspicious substance, don't sniff, touch, taste or look closely at it. Don't try to clean it up. Move away from the substance. Alert others in the area about the substance. Leave the area, close any doors and take actions to prevent others from entering the area. If possible, shut off the area's ventilation system. Those exposed to the substance should wash their hands with soap and water. Then report the substance to local law enforcement authorities. Seek additional instructions for exposed or potentially exposed people.

By Mayo Clinic Staff

Anemia Disease Information

If you have anemia, people may say you have tired blood. That's because anemia — a condition in which there aren't enough healthy red blood cells to carry adequate oxygen to your tissues — can make you feel tired.

There are many forms of anemia, each with its own cause. Anemia can be temporary or long term, and it can range from mild to severe.

Anemia is a common blood disorder. Women and people with chronic diseases are at increased risk of the condition.

If you suspect you have anemia, see your doctor. Anemia can be a sign of serious illnesses. Treatments for anemia range from taking supplements to undergoing medical procedures. You may be able to prevent some types of anemia by eating a healthy, varied diet.
Signs and symptoms

The main symptom of most types of anemia is fatigue. Other anemia symptoms include:
Weakness
Pale skin
A fast or irregular heartbeat
Shortness of breath
Chest pain
Dizziness
Cognitive problems
Numbness or coldness in your extremities
Headache

Initially, anemia can be so mild it goes unnoticed. But signs and symptoms increase as the condition worsens.
Causes

Blood consists of both a liquid called plasma and cells. Floating within the plasma are three types of blood cells:
White blood cells. These blood cells fight infection.
Platelets. These blood cells help your blood clot after a cut.
Red blood cells (erythrocytes). These blood cells carry oxygen from your lungs, via your bloodstream, to your brain and the other organs and tissues. Your body needs a supply of oxygenated blood to function. Oxygenated blood helps give your body its energy and your skin a healthy glow.

Red blood cells contain hemoglobin — a red, iron-rich protein that gives blood its red color. Hemoglobin enables red blood cells to carry oxygen from your lungs to all parts of your body, and to carry carbon dioxide from other parts of the body to the lungs so that it can be exhaled.

Most blood cells, including red blood cells, are produced regularly in your bone marrow — a red, spongy material found within the cavities of many of your large bones. To produce hemoglobin and red blood cells, your body needs iron, protein and vitamins from the foods you eat.

Anemia is a state in which the number of red blood cells or the hemoglobin in them is below normal. When you're anemic, your body produces too few healthy red blood cells, loses too many of them or destroys them faster than they can be replaced. As a result, your blood is low on red blood cells to carry oxygen to your tissues — leaving you fatigued. Common types of anemia and their causes include:

Iron deficiency anemia. This most common form of anemia affects about one in five women, half of pregnant women and 3 percent of men in the United States. The cause is a shortage of the element iron in your body. Your bone marrow needs iron to make hemoglobin. Without adequate iron, your body can't produce enough hemoglobin for red blood cells. The result is iron deficiency anemia.

One way your body gets needed iron is when blood cells die — the iron in them is recycled and used to produce new blood cells. So, if you lose blood, you lose iron. Women with heavy periods who lose a lot of blood each month during menstruation are at risk of iron deficiency anemia. Slow, chronic blood loss from a source within the body — such as an ulcer, a colon polyp or even colon cancer — also can lead to iron loss and iron deficiency anemia.

Your body also gets iron from the foods you eat. An iron-poor diet can lead to this anemia. In pregnant women, a growing fetus can deplete the mother's store of iron, leading to iron deficiency anemia.
Vitamin deficiency anemias. In addition to iron, your body needs folate and vitamin B-12 to produce sufficient numbers of healthy red blood cells. A diet lacking in these and other key nutrients can cause decreased red blood cell production. People who have an intestinal disorder that affects the absorption of nutrients are prone to this type of anemia. Some people are unable to absorb vitamin B-12 for a variety of reasons and develop vitamin B-12 deficiency anemia, which is sometimes called pernicious anemia. Vitamin deficiency anemias fall into a group of anemias called megaloblastic anemias, in which the bone marrow produces large, abnormal red blood cells.
Anemia of chronic disease. Certain chronic diseases — such as cancer, rheumatoid arthritis, Crohn's disease and other chronic inflammatory diseases — can interfere with the production of red blood cells, resulting in chronic anemia. Kidney failure also can be a cause of anemia. The kidneys produce a hormone called erythropoietin, which stimulates your bone marrow to produce red blood cells. A shortage of erythropoietin, which can result from kidney failure or be a side effect of chemotherapy, can result in a shortage of red blood cells.
Aplastic anemia. This is a life-threatening anemia caused by a decrease in the bone marrow's ability to produce all three types of blood cells — red blood cells, white blood cells and platelets. Many times, the cause of aplastic anemia is unknown, but it's believed to often be an autoimmune disease. Some factors that can be responsible for this type of anemia include chemotherapy, radiation therapy, environmental toxins, pregnancy and lupus.
Anemias associated with bone marrow disease. A variety of diseases, such as leukemia and myelodysplasia, a pre-leukemic condition, can cause anemia by affecting blood production in the bone marrow. The effects of these types of cancer and cancer-like disorders vary from a mild alteration in blood production to a complete, life-threatening shutdown of the blood-making process. Additionally, other cancers of the blood or bone marrow, such as multiple myeloma, myeloproliferative disorders and lymphoma, can cause anemia.
Hemolytic anemias. This group of anemias develops when red blood cells are destroyed faster than bone marrow can replace them. Certain blood diseases can cause increased red blood cell destruction. Autoimmune disorders can cause your body to produce antibodies to red blood cells, destroying them prematurely. Certain medications, such as some antibiotics used to treat infections, also can break down red blood cells. Hemolytic anemias may cause yellowing of the skin (jaundice) and an enlarged spleen.
Sickle cell anemia. This inherited and sometimes serious anemia, which affects mainly people of African and Arabic descent, is caused by a defective form of hemoglobin that forces red blood cells to assume an abnormal crescent (sickle) shape. These irregular-shaped red blood cells die prematurely, resulting in a chronic shortage of red blood cells. Sickle-shaped red blood cells can also block blood flow through small blood vessels in the body, producing other, often painful, symptoms.
Other anemias. There are several other, rarer forms of anemia, such as thalassemia and anemias caused by defective hemoglobin.

Sometimes, no cause of anemia can be identified.
Risk factors

These factors place you at increased risk of anemia:
Poor diet. Anyone — young or old — whose diet is consistently low in iron and vitamins, especially folate, is at risk of anemia. Your body needs iron, protein and vitamins to produce sufficient numbers of red blood cells.
Intestinal disorders. Having an intestinal disorder that affects the absorption of nutrients in the small intestine — such as Crohn's disease and celiac disease — puts you at risk of anemia. Surgical removal of or surgery to the parts of the small intestine where nutrients are absorbed can lead to nutrient deficiencies and anemia.
Menstruation. In general, women are at greater risk of iron deficiency anemia than are men. That's because women lose blood — and with it, iron — each month during menstruation.
Pregnancy. Pregnant women are at an increased risk of iron deficiency anemia because their iron stores have to serve the increased blood volume of the mother as well as be a source of hemoglobin for the growing fetus.
Chronic conditions. For example, if you have cancer, kidney or liver failure, or another chronic condition, you may be at risk of what's called anemia of chronic disease. These conditions can lead to a shortage of red blood cells. Slow, chronic blood loss from an ulcer or other source within the body can deplete your body's store of iron, leading to iron deficiency anemia.
Family history. If your family has a history of an inherited anemia, you also may be at increased risk of the condition.

Certain infections, blood diseases and autoimmune disorders, exposure to toxic chemicals, and the use of some medications can affect red blood cell production and lead to anemia. Other people at risk of anemia are people with diabetes, people who are dependent on alcohol (alcohol interferes with the absorption of folic acid) and people who adhere to a strict vegetarian diet, who may not get enough iron or vitamin B-12 in their diet.
When to seek medical advice

See your doctor if you're feeling fatigued for unexplained reasons, especially if you're at risk of anemia. Some anemias, such as iron deficiency anemia, are common. But don't assume that if you're tired, you must be anemic. Fatigue has many causes besides anemia.

Some people learn that their hemoglobin is low, which indicates anemia, when they go to donate blood. Low hemoglobin may be a temporary problem remedied by eating more iron-rich foods or taking a multivitamin containing iron. However, it may also be a warning sign of blood loss in your body that may be causing you to be deficient in iron. If you're told that you can't donate blood because of low hemoglobin, ask your doctor if you should be concerned.

If you have a family history of an inherited anemia, such as sickle cell anemia, talk to your doctor and possibly a genetic counselor about your risk and what risks you may pass on to your children.
Screening and diagnosis

Doctors diagnose anemia with the help of a medical history, a physical exam and blood tests, including a complete blood count (CBC). This blood test measures levels of red blood cells and hemoglobin in your blood. Some of your blood may also be examined under a microscope to study the size, shape and color of your red blood cells, which may indicate a diagnosis. For example, in iron deficiency anemia, red blood cells are smaller and paler in color than normal. In vitamin deficiency anemias, red blood cells are enlarged and fewer in number.

If you receive a diagnosis of anemia, your doctor may order additional tests to determine the underlying cause. For example, iron deficiency anemia can result from chronic bleeding of known or unknown ulcers, benign polyps in the colon, colon cancer, tumors, or kidney failure. Your doctor may test for these and other conditions that may underlie the anemia.

Occasionally, it may be necessary to study a sample of your bone marrow to diagnose anemia.
Complications

When anemia is severe enough, it may interfere with your ability to do everyday tasks. You may be too exhausted to work or play. Although anemia is often treatable, it may take several weeks to months for red blood cell levels to return to normal after treatment. Ask your doctor what to expect from treatment.

If you've been diagnosed with anemia — it's often detected during routine blood tests — ask your doctor what treatment is necessary. Then be sure to follow through on treatment, even if you quickly start to feel better. Left unchecked, anemia can lead to a rapid or irregular heartbeat — an arrhythmia. Your heart must pump more blood to compensate for the lack of oxygen in the blood when you're anemic. This can even lead to congestive heart failure. Untreated pernicious anemia can lead to nerve damage and decreased mental function, as vitamin B-12 is important not only for healthy red blood cells but also for optimal nerve and brain function.

Some inherited anemias, such as sickle cell anemia, can be serious and lead to life-threatening complications. Losing a lot of blood quickly results in acute, severe anemia and can be fatal.
Treatment

Anemia treatment depends on the cause:
Iron deficiency anemia. This form of anemia is treated with iron supplements, which you may need to take for several months or longer. If the underlying cause of iron deficiency is loss of blood — other than from menstruation — the source of the bleeding must be located and stopped. This may involve surgery.
Vitamin deficiency anemias. Pernicious anemia is treated with injections — often lifetime injections — of vitamin B-12. Folic acid deficiency anemia is treated with folic acid supplements.
Anemia of chronic disease. There's no specific treatment for this type of anemia. Doctors focus on treating the underlying disease. Iron supplements and vitamins generally don't help this type of anemia. However, if symptoms become severe, a blood transfusion or injections of synthetic erythropoietin, a hormone normally produced by the kidneys, may help stimulate red blood cell production and ease fatigue.
Aplastic anemia. Treatment for this serious anemia may include blood transfusions to boost levels of red blood cells. You may need a bone marrow transplant if your bone marrow is diseased and can't make healthy blood cells. You may need immune-suppressing medications to lessen your immune system's response and give the transplanted bone marrow a chance to start functioning again.
Anemias associated with bone marrow disease. Treatment of these various diseases can range from simple medication to chemotherapy to bone marrow transplantation. Treatment of these types of anemia usually involves a consultation from a blood specialist (hematologist).
Hemolytic anemias. Managing hemolytic anemias includes avoiding suspect medications, treating related infections and taking drugs that suppress your immune system, which may be attacking your red blood cells. Short courses of treatment with steroids or gamma globulin can help suppress your immune system's attack on your red blood cells. If the condition has caused an enlarged spleen, you may need to have your spleen removed. The spleen — a small organ below your rib cage on the left side — filters out and stores defective red blood cells. Certain hemolytic anemias can cause the spleen to become enlarged with damaged red blood cells.
Sickle cell anemia. Treatment for this incurable anemia may include the administration of oxygen, pain-relieving drugs, and oral and intravenous fluids to reduce pain and prevent complications. Doctors also commonly use blood transfusions, folic acid supplements and antibiotics. A bone marrow transplant may be an effective treatment in some circumstances. A cancer drug called hydroxyurea (Droxia, Hydrea) also is used to treat sickle cell anemia in adults.
Prevention

Many types of anemia can't be prevented. However, you can help avoid iron deficiency anemia and vitamin deficiency anemias by eating a healthy, varied diet that includes foods rich in iron, folate and vitamin B-12.

The best sources of iron are beef and other meats. Other foods rich in iron include beans, lentils, iron-fortified cereals, dark green leafy vegetables, dried fruit, nuts and seeds. Folate, and its synthetic form, folic acid, can be found in citrus juices and fruits, dark green leafy vegetables, legumes and fortified breakfast cereals. Vitamin B-12 is plentiful in meat and dairy products. Foods containing vitamin C, such as citrus fruits, help increase iron absorption.

Eating plenty of iron-containing foods is particularly important for people who have high iron requirements, such as children — iron is needed during growth spurts — and pregnant and menstruating women. Adequate iron intake is also crucial for infants, strict vegetarians and long-distance runners.

Doctors may prescribe iron supplements or multivitamins containing iron for people with high iron requirements. But iron supplements are appropriate only when you need more iron than a balanced diet can provide. Don't assume that if you're tired that you simply need to take iron supplements. Overloading your body with iron can be dangerous.

By Mayo Clinic Staff
Feb 21, 2007

HIV Infection and AIDS Disease Information

AIDS was first reported in the United States in 1981 and has since become a major worldwide epidemic. AIDS is caused by the human immunodeficiency virus, or HIV. By killing or damaging cells of the body's immune system, HIV progressively destroys the body's ability to fight infections and certain cancers. People diagnosed with AIDS may get life-threatening diseases called opportunistic infections. These infections are caused by microbes such as viruses or bacteria that usually do not make healthy people sick.

Since 1981, more than 980,000 cases of AIDS have been reported in the United States to the Centers for Disease Control and Prevention (CDC). According to CDC, more than 1,000,000 Americans may be infected with HIV, one-quarter of whom are unaware of their infection. The epidemic is growing most rapidly among minority populations and is a leading killer of African-American males ages 25 to 44. According, AIDS affects nearly seven times more African Americans and three times more Hispanics than whites. In recent years, an increasing number of African-American women and children are being affected by HIV/AIDS.
TRANSMISSION

HIV is spread most often through unprotected sex with an infected partner. The virus can enter the body through the lining of the vagina, vulva, penis, rectum, or mouth during sex.

Risky behavior

HIV can infect anyone who practices risky behaviors such as
Sharing drug needles or syringes
Having sexual contact, including oral sexual contact, with an infected person without using a condom
Having sexual contact with someone whose HIV status is unknown

Infected blood

HIV also is spread through contact with infected blood. Before donated blood was screened for evidence of HIV infection and before heat-treating techniques to destroy HIV in blood products were introduced, HIV was transmitted through transfusions of contaminated blood or blood components. Today, because of blood screening and heat treatment, the risk of getting HIV from blood transfusions is extremely small.

Contaminated needles

HIV is often spread among injection drug users when they share needles or syringes contaminated with very small quantities of blood from someone infected with the virus.

It is rare for a patient to be the source of HIV transmitted to a healthcare provider or vice versa by accidental sticks with contaminated needles or other medical instruments.

Mother to child

Women can transmit HIV to their babies during pregnancy or birth. Approximately one-quarter to one-third of all untreated pregnant women infected with HIV will pass the infection to their babies. HIV also can be spread to babies through the breast milk of mothers infected with the virus. If the mother takes certain drugs during pregnancy, she can significantly reduce the chances that her baby will get infected with HIV. If healthcare providers treat HIV-infected pregnant women and deliver their babies by cesarean section, the chances of the baby being infected can be reduced to a rate of 1 percent. HIV infection of newborns has been almost eradicated in the United States because of appropriate treatment.

A study sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) in Uganda found a highly effective and safe drug for preventing transmission of HIV from an infected mother to her newborn. Independent studies have also confirmed this finding. This regimen is more affordable and practical than any other examined to date. Results from the study show that a single oral dose of the antiretroviral drug nevirapine (NVP) given to an HIV-infected woman in labor and another to her baby within 3 days of birth reduces the transmission rate of HIV by half compared with a similar short course of AZT (azidothymidine).

Saliva

Although researchers have found HIV in the saliva of infected people, there is no evidence that the virus is spread by contact with saliva. Laboratory studies reveal that saliva has natural properties that limit the power of HIV to infect, and the amount of virus in saliva appears to be very low. Research studies of people infected with HIV have found no evidence that the virus is spread to others through saliva by kissing. The lining of the mouth, however, can be infected by HIV, and instances of HIV transmission through oral intercourse have been reported.

Scientists have found no evidence that HIV is spread through sweat, tears, urine, or feces.

Casual contact

Studies of families of HIV-infected people have shown clearly that HIV is not spread through casual contact such as the sharing of food utensils, towels and bedding, swimming pools, telephones, or toilet seats.

HIV is not spread by biting insects such as mosquitoes or bedbugs.

Sexually transmitted infections

People with a sexually transmitted infection, such as syphilis, genital herpes, chlamydia, gonorrhea, or bacterial vaginosis, may be more susceptible to getting HIV infection during sex with infected partners.
SYMPTOMS

Early symptoms

Many people will not have any symptoms when they first become infected with HIV. They may, however, have a flu-like illness within a month or two after exposure to the virus. This illness may include
Fever
Headache
Tiredness
Enlarged lymph nodes (glands of the immune system easily felt in the neck and groin)

These symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, people are very infectious, and HIV is present in large quantities in genital fluids.

Later symptoms

More persistent or severe symptoms may not appear for 10 years or more after HIV first enters the body in adults, or within 2 years in children born with HIV infection. This period of asymptomatic infection varies greatly in each person. Some people may begin to have symptoms within a few months, while others may be symptom-free for more than 10 years.

Even during the asymptomatic period, the virus is actively multiplying, infecting, and killing cells of the immune system. The virus can also hide within infected cells and be inactive. The most obvious effect of HIV infection is a decline in the number of CD4 positive T (CD4+) cells found in the blood-the immune system's key infection fighters. The virus slowly disables or destroys these cells without causing symptoms.

As the immune system becomes more debilitated, a variety of complications start to take over. For many people, the first signs of infection are large lymph nodes, or swollen glands that may be enlarged for more than 3 months. Other symptoms often experienced months to years before the onset of AIDS include
Lack of energy
Weight loss
Frequent fevers and sweats
Persistent or frequent yeast infections (oral or vaginal)
Persistent skin rashes or flaky skin
Pelvic inflammatory disease in women that does not respond to treatment
Short-term memory loss

Some people develop frequent and severe herpes infections that cause mouth, genital, or anal sores, or a painful nerve disease called shingles. Children may grow slowly or get sick a frequently.
WHAT IS AIDS?

Symptoms of opportunistic infections common in people with AIDS include
Coughing and shortness of breath
Seizures and lack of coordination
Difficult or painful swallowing
Mental symptoms such as confusion and forgetfulness
Severe and persistent diarrhea
Fever
Vision loss
Nausea, abdominal cramps, and vomiting
Weight loss and extreme fatigue
Severe headaches
Coma

Children with AIDS may get the same opportunistic infections as do adults with the disease. In addition, they also may have severe forms of the typically common childhood bacterial infections, such as conjunctivitis (pink eye), ear infections, and tonsillitis.

People with AIDS are also particularly prone to developing various cancers, especially those caused by viruses such as Kaposi's sarcoma and cervical cancer, or cancers of the immune system known as lymphomas. These cancers are usually more aggressive and difficult to treat in people with AIDS. Signs of Kaposi's sarcoma in light-skinned people are round brown, reddish, or purple spots that develop in the skin or in the mouth. In dark-skinned people, the spots are more pigmented.

During the course of HIV infection, most people experience a gradual decline in the number of CD4+ T cells, although some may have abrupt and dramatic drops in their CD4+ T-cell counts. A person with CD4+ T cells above 200 may experience some of the early symptoms of HIV disease. Others may have no symptoms even though their CD4+ T-cell count is below 200.

Many people are so debilitated by the symptoms of AIDS that they cannot hold a steady job or do household chores. Other people with AIDS may experience phases of intense life-threatening illness followed by phases in which they function normally.

A small number of people first infected with HIV 10 or more years ago have not developed symptoms of AIDS. Scientists are trying to determine what factors may account for the lack of progression to AIDS in some people, such as
Whether their immune systems have particular characteristics
Whether they were infected with a less aggressive strain of the virus
If their genes may protect them from the effects of HIV

Scientists hope that understanding the body's natural method of controlling infection may lead to ideas for protective HIV vaccines and use of vaccines to prevent the disease from progressing.
DIAGNOSIS

Because early HIV infection often causes no symptoms, a healthcare provider usually can diagnose it by testing blood for the presence of antibodies (disease-fighting proteins) to HIV. HIV antibodies generally do not reach noticeable levels in the blood for 1 to 3 months after infection. It may take the antibodies as long as 6 months to be produced in quantities large enough to show up in standard blood tests. Hence, to determine whether a person has been recently infected (acute infection), a healthcare provider can screen blood for the presence of HIV genetic material. Direct screening of HIV is extremely critical in order to prevent transmission of HIV from recently infected individuals.

Anyone who has been exposed to the virus should get an HIV test as soon as the immune system is likely to develop antibodies to the virus-within 6 weeks to 12 months after possible exposure to the virus. By getting tested early, a healthcare provider can give advice to an infected person about when to start treatment to help the immune system combat HIV and help prevent the emergence of certain opportunistic infections (see section on treatment). Early testing also alerts an infect person to avoid high-risk behaviors that could spread the virus to others.

Most healthcare providers can do HIV testing and will usually offer counseling at the same time. Of course, testing can be done anonymously at many sites if a person is concerned about confidentiality.

Healthcare providers diagnose HIV infection by using two different types of antibody tests: ELISA (enzyme-linked immunosorbent assay) and Western blot. If a person is highly likely to be infected with HIV but has tested negative for both tests, a healthcare provider may request additional tests. A person also may be told to repeat antibody testing at a later date, when antibodies to HIV are more likely to have developed.

Babies born to mothers infected with HIV may or may not be infected with the virus, but all carry their mothers' antibodies to HIV for several months. If these babies lack symptoms, healthcare providers cannot make a definitive diagnosis of HIV infection using standard antibody tests. Instead, they are using new technologies to detect HIV and more accurately determine HIV infection in infants between ages 3 months and 15 months. Researchers are evaluating a number of blood tests to determine which ones are best for diagnosing HIV infection in babies younger than 3 months.
TREATMENT

When AIDS first surfaced in the United States, there were no drugs to combat the underlying immune deficiency and few treatments existed for the opportunistic diseases that resulted. Researchers, however, have developed drugs to fight both HIV infection and its associated infections and cancers.

HIV infection

The Food and Drug Administration (FDA) has approved a number of drugs for treating HIV infection. The first group of drugs, called reverse transcriptase (RT) inhibitors, interrupts an early stage of the virus making copies of itself. Nucleoside/nucleotide RT inhibitors are faulty DNA building blocks. When these faulty pieces are incorporated into the HIV DNA (during the process when the HIV RNA is converted to HIV DNA), the DNA chain cannot be completed, thereby blocking HIV from replicating in a cell. Non-nucleoside RT inhibitors bind to reverse transcriptase, interfering with its ability to convert the HIV RNA into HIV DNA. This class of drugs may slow the spread of HIV in the body and delay the start of opportunistic infections.

FDA has approved a second class of drugs for treating HIV infection. These drugs, called protease inhibitors, interrupt the virus from making copies of itself at a later step in its life cycle.

FDA also has introduced a third new class of drugs, known at fusion inhibitors, to treat HIV infection. Fuzeon (enfuvirtide or T-20), the first approved fusion inhibitor, works by interfering with the ability of HIV-1 to enter into cells by blocking the merging of the virus with the cell membranes. This inhibition blocks HIV's ability to enter and infect the human immune cells. Fuzeon is designed for use in combination with other anti-HIV treatments. It reduces the level of HIV infection in the blood and may be effective against HIV that has become resistant to current antiviral treatment schedules.

Because HIV can become resistant to any of these drugs, healthcare providers must use a combination treatment to effectively suppress the virus. When multiple drugs (three or more) are used in combination, it is referred to as highly active antiretroviral therapy, or HAART, and can be used by people who are newly infected with HIV as well as people with AIDS. Recently, FDA approved the first one-a-day three drug-combination pill called Atripla.

Researchers have credited HAART as being a major factor in significantly reducing the number of deaths from AIDS in this country. While HAART is not a cure for AIDS, it has greatly improved the health of many people with AIDS and it reduces the amount of virus circulating in the blood to nearly undetectable levels. Researchers, however, have shown that HIV remains present in hiding places, such as the lymph nodes, brain, testes, and retina of the eye, even in people who have been treated.

Side effects

Despite the beneficial effects of HAART, there are side effects associated with the use of antiviral drugs that can be severe. Some of the nucleoside RT inhibitors may cause a decrease of red or white blood cells, especially when taken in the later stages of the disease. Some may also cause inflammation of the pancreas and painful nerve damage. There have been reports of complications and other severe reactions, including death, to some of the antiretroviral nucleoside analogs when used alone or in combination. Therefore, health experts recommend that anyone on antiretroviral therapy be routinely seen and followed by their healthcare provider.

The most common side effects associated with protease inhibitors include nausea, diarrhea, and other gastrointestinal symptoms. In addition, protease inhibitors can interact with other drugs resulting in serious side effects. Fuzeon may also cause severe allergic reactions such as pneumonia, trouble breathing, chills and fever, skin rash, blood in urine, vomiting, and low blood pressure. Local skin reactions are also possible since it is given as an injection underneath the skin. People taking HIV drugs should contact their healthcare providers immediately if they have any of these symptoms.

Opportunistic infections

A number of available drugs help treat opportunistic infections. These drugs include
Foscarnet and ganciclovir to treat CMV (cytomegalovirus) eye infections
Fluconazole to treat yeast and other fungal infections
TMP/SMX (trimethoprim/sulfamethoxazole) or pentamidine to treat PCP (Pneumocystis carinii pneumonia)

Cancers

Healthcare providers use radiation, chemotherapy, or injections of alpha interferon-a genetically engineered protein that occurs naturally in the human body-to treat Kaposi's sarcoma or other cancers associated with HIV infection.
PREVENTION

Because there is no vaccine for HIV, the only way people can prevent infection with the virus is to avoid behaviors putting them at risk of infection, such as sharing needles and having unprotected sex.

Many people infected with HIV have no symptoms. Therefore, there is no way of knowing with certainty whether a sexual partner is infected unless he or she has repeatedly tested negative for the virus and has not engaged in any risky behavior. Abstaining from having sex or use male latex condoms or female polyurethane condoms may offer partial protection, during oral, anal, or vaginal sex. Only water-based lubricants should be used with male latex condoms.

Although some laboratory evidence shows that spermicides can kill HIV, researchers have not found that these products can prevent a person from getting HIV.

Recently, NIAID-supported two studies that found adult male medical circumcision reduces a man's risk of acquiring HIV infection by approximately 50 percent. The studies, conducted in Uganda and Kenya, pertain only to heterosexual transmission. As with most prevention strategies, adult male medical circumcision is not completely effective at preventing HIV transmission. Circumcision will be most effective when it is part of a more complete prevention strategy including the ABCs (Abstinence, Be Faithful, Use Condoms) of HIV prevention.
RESEARCH

NIAID-supported investigators are conducting an abundance of research on all areas of HIV infection, including developing and testing preventive HIV vaccines, prevention strategies, and new treatments for HIV infection and AIDS-associated opportunistic infections. Researchers also are investigating exactly how HIV damages the immune system. This research is identifying new and more effective targets for drugs and vaccines. NIAID-supported investigators also continue to trace how the disease progresses in different people.

Scientists are investigating and testing chemical barriers, such as topical microbicides, that people can use in the vagina or in the rectum during sex to prevent HIV transmission. They also are looking at other ways to prevent transmission, such as controlling STIs, modifying personal behavior, and pre-exposure prophylaxis (PrEP), as well as ways to prevent transmission from mother to child.
LINKS

AIDSinfo
P.O. Box 6303
Rockville, MD 20849-6303
1-800-HIV-0440 (1-800-448-0440) or 301-519-0459
1-888-480-3739 (TTY/TDD)

Acupuncture Information

Acupuncture is among the oldest healing practices in the world. As part of traditional Chinese medicine (TCM), acupuncture aims to restore and maintain health through the stimulation of specific points on the body. In the United States, where practitioners incorporate healing traditions from China, Japan, Korea, and other countries, acupuncture is considered part of complementary and alternative medicine (CAM).

Key Points
Acupuncture has been practiced in China and other Asian countries for thousands of years.
Scientists are studying the efficacy of acupuncture for a wide range of conditions.
Relatively few complications have been reported from the use of acupuncture. However, acupuncture can cause potentially serious side effects if not delivered properly by a qualified practitioner.
Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

About Acupuncture

The term "acupuncture" describes a family of procedures involving the stimulation of anatomical points on the body using a variety of techniques. The acupuncture technique that has been most often studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.

Practiced in China and other Asian countries for thousands of years, acupuncture is one of the key components of traditional Chinese medicine. In TCM, the body is seen as a delicate balance of two opposing and inseparable forces: yin and yang. Yin represents the cold, slow, or passive principle, while yang represents the hot, excited, or active principle. According to TCM, health is achieved by maintaining the body in a "balanced state"; disease is due to an internal imbalance of yin and yang. This imbalance leads to blockage in the flow of qi (vital energy) along pathways known as meridians. Qi can be unblocked, according to TCM, by using acupuncture at certain points on the body that connect with these meridians. Sources vary on the number of meridians, with numbers ranging from 14 to 20. One commonly cited source describes meridians as 14 main channels "connecting the body in a weblike interconnecting matrix" of at least 2,000 acupuncture points.

Acupuncture became better known in the United States in 1971, when New York Times reporter James Reston wrote about how doctors in China used needles to ease his pain after surgery. American practices of acupuncture incorporate medical traditions from China, Japan, Korea, and other countries.

Acupuncture Use in the United States

The report from a Consensus Development Conference on Acupuncture held at the National Institutes of Health (NIH) in 1997 stated that acupuncture is being "widely" practiced—by thousands of physicians, dentists, acupuncturists, and other practitioners-for relief or prevention of pain and for various other health conditions. According to the 2002 National Health Interview Survey—the largest and most comprehensive survey of CAM use by American adults to date—an estimated 8.2 million U.S. adults had ever used acupuncture, and an estimated 2.1 million U.S. adults had used acupuncture in the previous year.

Acupuncture Side Effects and Risks

The U.S. Food and Drug Administration (FDA) regulates acupuncture needles for use by licensed practitioners, requiring that needles be manufactured and labeled according to certain standards. For example, the FDA requires that needles be sterile, nontoxic, and labeled for single use by qualified practitioners only.

Relatively few complications from the use of acupuncture have been reported to the FDA, in light of the millions of people treated each year and the number of acupuncture needles used. Still, complications have resulted from inadequate sterilization of needles and from improper delivery of treatments. Practitioners should use a new set of disposable needles taken from a sealed package for each patient and should swab treatment sites with alcohol or another disinfectant before inserting needles. When not delivered properly, acupuncture can cause serious adverse effects, including infections and punctured organs.

Status of Acupuncture Research

There have been many studies on acupuncture's potential health benefits for a wide range of conditions. Summarizing earlier research, the 1997 NIH Consensus Statement on Acupuncture found that, overall, results were hard to interpret because of problems with the size and design of the studies.

In the years since the Consensus Statement was issued, the National Center for Complementary and Alternative Medicine (NCCAM) has funded extensive research to advance scientific understanding of acupuncture. Some recent NCCAM-supported studies have looked at:
Whether acupuncture works for specific health conditions such as chronic low-back pain, headache, and osteoarthritis of the knee
How acupuncture might work, such as what happens in the brain during acupuncture treatment
Ways to better identify and understand the potential neurological properties of meridians and acupuncture points
Methods and instruments for improving the quality of acupuncture research

Finding a Qualified Practitioner

Health care providers can be a resource for referral to acupuncturists, and some conventional medical practitioners—including physicians and dentists—practice acupuncture. In addition, national acupuncture organizations (which can be found through libraries or Web search engines) may provide referrals to acupuncturists.
Check a practitioner's credentials. Most states require a license to practice acupuncture; however, education and training standards and requirements for obtaining a license to practice vary from state to state. Although a license does not ensure quality of care, it does indicate that the practitioner meets certain standards regarding the knowledge and use of acupuncture.

Do not rely on a diagnosis of disease by an acupuncture practitioner who does not have substantial conventional medical training. If you have received a diagnosis from a doctor, you may wish to ask your doctor whether acupuncture might help.

What To Expect from Acupuncture Visits

During your first office visit, the practitioner may ask you at length about your health condition, lifestyle, and behavior. The practitioner will want to obtain a complete picture of your treatment needs and behaviors that may contribute to your condition. Inform the acupuncturist about all treatments or medications you are taking and all medical conditions you have.

Acupuncture needles are metallic, solid, and hair-thin. People experience acupuncture differently, but most feel no or minimal pain as the needles are inserted. Some people feel energized by treatment, while others feel relaxed. Improper needle placement, movement of the patient, or a defect in the needle can cause soreness and pain during treatment. This is why it is important to seek treatment from a qualified acupuncture practitioner.

Treatment may take place over a period of several weeks or more.

Treatment Costs

Ask the practitioner about the estimated number of treatments needed and how much each treatment will cost. Some insurance companies may cover the costs of acupuncture, while others may not. It is important to check with your insurer before you start treatment to see whether acupuncture is covered for your condition and, if so, to what extent. (For more information, see NCCAM's fact sheet Paying for CAM Treatment.)

References
Acupuncture. Natural Standard Database Web site. Accessed at http://www.naturalstandard.com on June 28, 2007.
Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002. CDC Advance Data Report #343. 2004.
Berman BM, Lao L, Langenberg P, et al. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Annals of Internal Medicine. 2004;141(12):901–910.
Eisenberg DM, Cohen MH, Hrbek A, et al. Credentialing complementary and alternative medical providers. Annals of Internal Medicine. 2002;137(12):965–973.
Ernst E. Acupuncture—a critical analysis. Journal of Internal Medicine. 2006;259(2):125–137.
Kaptchuk, TJ. Acupuncture: theory, efficacy, and practice. Annals of Internal Medicine. 2002;136(5):374–383.
Lao L. Safety issues in acupuncture. Journal of Alternative and Complementary Medicine. 1996;2(1):27–31.
MacPherson H, Thomas K. Short-term reactions to acupuncture—a cross-sectional survey of patient reports. Acupuncture in Medicine. 2005;23(3):112–120.
National Cancer Institute. Acupuncture (PDQ). National Cancer Institute Web site. Accessed at http://www.cancer.gov/cancertopics/pdq/cam/acupuncture on August 16, 2007.
National Institutes of Health Consensus Panel. Acupuncture: National Institutes of Health Consensus Development Conference Statement. National Institutes of Health Web site. Accessed at http://consensus.nih.gov/1997/1997acupuncture107html.htm on June 22, 2007.
Reston J. Now, about my operation in Peking; Now, let me tell you about my appendectomy in Peking…. New York Times. July 26, 1971:1.
U.S. Food and Drug Administration. Acupuncture needles no longer investigational. FDA Consumer. 1996;30(5). Also available at http://www.fda.gov/fdac/departs/596_upd.html.

For More Information

NCCAM Clearinghouse

The NCCAM Clearinghouse provides information on CAM and NCCAM, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

Toll-free in the U.S.: 1-888-644-6226
TTY (for deaf and hard-of-hearing callers): 1-866-464-3615
Web site: nccam.nih.gov
E-mail: info@nccam.nih.gov

Acne Disease Information

Acne is a disease that affects the skin's oil glands. The small holes in your skin (pores) connect to oil glands under the skin. These glands make an oily substance called sebum. The pores connect to the glands by a canal called a follicle. Inside the follicles, oil carries dead skin cells to the surface of the skin. A thin hair also grows through the follicle and out to the skin. When the follicle of a skin gland clogs up, a pimple grows.

Most pimples are found on the face, neck, back, chest, and shoulders. Acne is not a serious health threat but, it can cause scars.

How Does Acne Develop?
Who Gets Acne?
What Causes Acne?
How Is Acne Treated?
How Should People With Acne Care for Their Skin?
What Things Can Make Acne Worse?
What Are Some Myths About the Causes of Acne?
What Research Is Being Done on Acne?
How Does Acne Develop?

Sometimes, the hair, sebum, and skin cells clump together into a plug. The bacteria in the plug causes swelling. Then when the plug starts to break down, a pimple grows.

There are many types of pimples. The most common types are:
Whiteheads. These are pimples that stay under the surface of the skin.
Blackheads. These pimples rise to the skin's surface and look black. The black color is not from dirt.
Papules. These are small pink bumps that can be tender.
Pustules. These pimples are red at the bottom and have pus on top.
Nodules. These are large, painful, solid pimples that are deep in the skin.
Cysts. These deep, painful, pus-filled pimples can cause scars.
Who Gets Acne?

Acne is the most common skin disease. People of all races and ages get acne. But it is most common in teenagers and young adults. An estimated 80 percent of all people between the ages of 11 and 30 have acne outbreaks at some point. Some people in their forties and fifties still get acne.
What Causes Acne?

The cause of acne is unknown. Doctors think certain factors might cause it:
The hormone increase in teenage years (this can cause the oil glands to plug up more often)
Hormone changes during pregnancy
Starting or stopping birth control pills
Heredity (if your parents had acne, you might get it, too)
Some types of medicine
Greasy makeup.
How Is Acne Treated?

Acne is treated by doctors who work with skin problems (dermatologists). Treatment tries to:
Heal pimples
Stop new pimples from forming
Prevent scarring
Help reduce the embarrassment of having acne.

Early treatment is the best way to prevent scars. Your doctor may suggest over-the-counter (OTC) or prescription drugs. Some acne medicines are put right on the skin. Other medicines are pills that you swallow. The doctor may tell you to use more than one medicine.
How Should People With Acne Care for Their Skin?

Here are some ways to care for skin if you have acne:
Clean skin gently. Use a mild cleanser in the morning, evening, and after heavy workouts. Scrubbing the skin does not stop acne. It can even make the problem worse.
Try not to touch your skin. People who squeeze, pinch, or pick their pimples can get scars or dark spots on their skin.
Shave carefully. If you shave, you can try both electric and safety razors to see which works best. With safety razors, use a sharp blade. Also, it helps to soften your beard with soap and water before putting on shaving cream. Shave lightly and only when you have to.
Stay out of the sun. Many acne medicines can make people more likely to sunburn. Being in the sun a lot can also make skin wrinkle and raise the risk of skin cancer.
Choose makeup carefully. All makeup should be oil free. Look for the word “noncomedogenic” on the label. This means that the makeup will not clog up your pores. But some people still get acne even if they use these products.
What Things Can Make Acne Worse?

Some things can make acne worse:
Changing hormone levels in teenage girls and adult women 2 to 7 days before their period starts
Pressure from bike helmets, backpacks, or tight collars
Pollution and high humidity
Squeezing or picking at pimples
Hard scrubbing of the skin.
What Are Some Myths About the Causes of Acne?

There are many myths about what causes acne. Dirty skin and stress do not cause acne. Also, chocolate and greasy foods do not cause acne in most people.
What Research Is Being Done on Acne?

Scientists are looking at new ways to treat acne. They are:
Working on new drugs to treat acne
Looking at ways to prevent plugs
Looking at ways to stop the hormone testosterone from causing acne.

Influenza (Flu) Disease Information

The flu is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death. The best way to prevent the flu is by getting a flu vaccination each year.

Every year in the United States, on average:
5% to 20% of the population gets the flu;
more than 200,000 people are hospitalized from flu complications, and;
about 36,000 people die from flu.

Some people, such as older people, young children, and people with certain health conditions (such as asthma, diabetes, or heart disease), are at high risk for serious flu complications.
Symptoms of Flu

Symptoms of flu include:
fever (usually high)
headache
extreme tiredness
dry cough
sore throat
runny or stuffy nose
muscle aches
Stomach symptoms, such as nausea, vomiting, and diarrhea, also can occur but are more common in children than adults
Complications of Flu

Complications of flu can include bacterial pneumonia, ear infections, sinus infections, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes.
How Flu Spreads

Flu viruses spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose. Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.
Preventing Seasonal Flu: Get Vaccinated

The single best way to prevent the flu is to get a flu vaccination each year. There are two types of vaccines:
The "flu shot" – an inactivated vaccine (containing killed virus) that is given with a needle. The flu shot is approved for use in people 6 months of age and older, including healthy people and people with chronic medical conditions.
The nasal-spray flu vaccine – a vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for “Live Attenuated Influenza Vaccine”). LAIV is approved for use in healthy* people 2-49 years of age† who are not pregnant.

About two weeks after vaccination, antibodies develop that protect against influenza virus infection. Flu vaccines will not protect against flu-like illnesses caused by non-influenza viruses.
When to Get Vaccinated

October or November is the best time to get vaccinated, but you can still get vaccinated in December and later. Flu season can begin as early as October and last as late as May.
Who Should Get Vaccinated?

In general, anyone who wants to reduce their chances of getting the flu can get vaccinated. However, certain people should get vaccinated each year either because they are at high risk of having serious flu-related complications or because they live with or care for high risk persons. During flu seasons when vaccine supplies are limited or delayed, the Advisory Committee on Immunization Practices (ACIP) makes recommendations regarding priority groups for vaccination.
People who should get vaccinated each year are:
People at high risk for complications from the flu, including:
Children aged 6 months until their 5th birthday,
Pregnant women,
People 50 years of age and older,
People of any age with certain chronic medical conditions, and
People who live in nursing homes and other long term care facilities.
People who live with or care for those at high risk for complications from flu, including:
Household contacts of persons at high risk for complications from the flu (see above)
Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)
Health care workers.
Anyone who wants to decrease their risk of influenza.
Use of the Nasal Spray Flu Vaccine

Vaccination with the nasal-spray flu vaccine is an option for healthy* people 2-49 years of age† who are not pregnant, even healthy persons who live with or care for those in a high risk group. The one exception is healthy persons who care for persons with severely weakened immune systems who require a protected environment; these healthy persons should get the inactivated vaccine.
Who Should Not Be Vaccinated

Some people should not be vaccinated without first consulting a physician. They include:
People who have a severe allergy to chicken eggs.
People who have had a severe reaction to an influenza vaccination in the past.
People who developed Guillain-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine previously.
Children less than 6 months of age (influenza vaccine is not approved for use in this age group).
People who have a moderate or severe illness with a fever should wait to get vaccinated until their symptoms lessen.

Emphysema Disease Information

Emphysema is a progressive lung disease that results in shortness of breath and reduces your capacity for physical activity.

The cause of emphysema is damage to the small air sacs and small airways in your lungs. This damage obstructs airflow when you exhale.

When emphysema is advanced, you must work so hard to expel air from your lungs that just the simple act of breathing can consume a great deal of energy. Unfortunately, because emphysema develops gradually over many years, you may not experience symptoms such as shortness of breath until irreversible damage has already occurred.

Treatments for emphysema focus on relieving symptoms and avoiding complications.
Signs and symptoms

The main emphysema symptoms are shortness of breath and a reduced capacity for physical activity, both of which worsen as the disease progresses. In time, you may have trouble breathing even when lying down, and it may be especially hard to breathe during and after respiratory infections, such as colds or the flu.

Other signs and symptoms of emphysema include:
Chronic, mild cough. Cough is uncommon with emphysema. When it does occur, it's usually nonproductive, which means that you won't bring up much phlegm when you cough. If you have a chronic productive cough, you may have chronic bronchitis — another form of chronic obstructive pulmonary disease (COPD) — rather than emphysema.
Loss of appetite and weight loss. It's a vicious cycle. Emphysema can make eating more difficult, and the act of eating can rob you of your breath. The result is that you simply may not feel like eating much of the time. Also, when you eat, your stomach expands and pushes up the diaphragm, which compresses the lungs and makes it harder to breathe.
Fatigue. You're likely to feel tired both because it's more difficult to breathe and because your body is getting less oxygen. You also become out of shape because exercise makes you short of breath.
Causes

When you inhale, air travels to your lungs through two major airways off the windpipe (trachea) called bronchi. Inside your lungs, the bronchi subdivide like the roots of a tree into a million smaller airways (bronchioles) that finally end in clusters of tiny air sacs (alveoli). You have about 300 million air sacs in each lung.

Within the walls of the air sacs are tiny blood vessels (capillaries) where oxygen is added to your blood and carbon dioxide — a waste product of metabolism — is removed. The air sac walls also contain elastic fibers that help the very small airways leading to the air sacs expand like small balloons when you breathe.

What happens in emphysema
In emphysema, inflammation destroys these fragile walls of the air sacs, causing them to lose their elasticity. As a result, the bronchioles collapse, and air becomes trapped in the air sacs, which overstretches them and interferes with your ability to exhale (hyperinflation).

In time, this overstretching may cause several air sacs to rupture, forming one larger air space instead of many small ones. Because the larger, less elastic sacs aren't able to force air completely out of your lungs when you exhale, you have to breathe harder to take in enough oxygen and to eliminate carbon dioxide.

The process works something like this: Normally, you exhale in two ways, actively and passively. When you sit quietly, your diaphragm contracts and your chest muscles expand to take air in, but your muscles don't actively contract to let the air out. Instead, the elastic tissue around your air sacs contracts and your lungs passively shrink. On the other hand, when you exert yourself and need more oxygen, your chest muscles contract, forcing air out rapidly.

But if you have emphysema, many of these elastic fibers have been destroyed, and you must consciously force air out of your lungs. The forced exhalation compresses many of your small airways, making expelling air even more difficult.

Most common cause is smoking
Cigarette smoke is by far the most common cause of emphysema. The damage begins when tobacco smoke temporarily paralyzes the microscopic hairs (cilia) that line your bronchial tubes. Normally, these hairs sweep irritants and germs out of your airways. But when smoke interferes with this sweeping movement, irritants remain in your bronchial tubes and infiltrate the alveoli, inflaming the tissue and eventually breaking down elastic fibers.

Protein deficiency sometimes plays a role
In a small percentage of people, emphysema results from low levels of a protein called alpha-1-antitrypsin (AAt), which protects the elastic structures in your lungs from the destructive effects of certain enzymes. A lack of AAt can lead to progressive lung damage that eventually results in emphysema. If you're a smoker with a lack of AAt, emphysema can begin in your 30s and 40s.

AAt deficiency is a hereditary condition that occurs when you inherit two defective genes, one from each parent. Although severe AAt deficiency is rare, millions of people carry a single defective AAt gene. Some of these people have mild to moderate symptoms; others have no symptoms at all. Carriers are at increased risk of lung and liver problems and can pass the defect to their children.

People with two defective genes have a high likelihood of developing emphysema, usually between the ages of 30 and 40. The progression and severity of the disease are greatly exacerbated by smoking.

Experts recommend that people with early-onset emphysema — especially those who don't smoke or who have other risk factors for the disease or who have a family history of AAt deficiency — be tested for the defective gene. People who are found to have a genetic predisposition for AAt deficiency may want to consider having close family members tested as well.
Risk factors

The single greatest risk factor for emphysema is smoking. Emphysema is most likely to develop in cigarette smokers, but cigar and pipe smokers also are susceptible, and the risk for all types of smokers increases with the number of years and amount of tobacco smoked. Men are affected more often than women are, but this statistic is changing, as more women have taken up smoking.

Other risk factors include:
Age. Although the lung damage that occurs in emphysema develops gradually, most people with tobacco-related emphysema begin to experience symptoms of the disease between the ages of 50 and 60.
Exposure to secondhand smoke. Secondhand smoke, also known as passive or environmental tobacco smoke, is smoke that you inadvertently inhale from someone else's cigarette, pipe or cigar. Being around secondhand smoke increases your risk of emphysema.
Occupational exposure to chemical fumes. If you breathe fumes from certain chemicals or dust from grain, cotton, wood or mining products, you're more likely to develop emphysema. This risk is even greater if you smoke.
Exposure to indoor and outdoor pollution. Breathing indoor pollutants such as fumes from heating fuel as well as outdoor pollutants — car exhaust, for instance — increases your risk of emphysema.
Heredity. A rare, inherited deficiency of the protein alpha-1-antitrypsin (AAt) can cause emphysema, especially before age 50, and even earlier if you smoke.
HIV infection. Smokers living with HIV are at greater risk of emphysema than are smokers who don't have HIV infection.
Connective tissue disorders. Some conditions that affect connective tissue — the fibers that provide the framework and support for your body — are associated with emphysema. These conditions include cutis laxa, a rare disease that causes premature aging, and Marfan syndrome, a disorder that affects many different organs, especially the heart, eyes, skeleton and lungs.
When to seek medical advice

See your doctor if any of the following apply to you:
You feel short of breath most of the time.
You can't breathe well enough to tolerate even moderate exercise.
You frequently cough up sputum that's colored and possibly infected.

These signs and symptoms don't necessarily mean you have emphysema, but they do indicate that your lungs aren't working properly and should be evaluated by your doctor as soon as possible.
Screening and diagnosis

CLICK TO ENLARGE Spirometer



To determine if you have emphysema, your doctor is likely to recommend certain tests, including:
Pulmonary function tests (PFTs). These noninvasive tests can detect emphysema before you have symptoms. They measure how much air your lungs can hold and the flow of air in and out of your lungs. They can also measure the amount of gases exchanged across the membrane between your alveolar wall and capillary membrane. During the test, you're usually asked to blow into a simple instrument called a spirometer. PFTs may be done before and after the use of inhaled medications to test your response to them. If you're a smoker or a former smoker, ask your doctor about taking this test, even if you don't have symptoms of COPD.
Chest X-ray. You're likely to have a chest X-ray to help rule out other lung problems rather than to diagnose emphysema — because even in the advanced stages of the disease, chest X-rays are often normal.
Arterial blood gases analysis. These blood tests measure how well your lungs transfer oxygen to your bloodstream and how effectively they remove carbon dioxide.
Pulse oximetry. This test involves the use of a small device that attaches to your fingertip. The oximeter measures the amount of oxygen in your blood differently from the way it's measured in a blood gas analysis. To help determine whether you need supplemental oxygen, the test may be performed at rest, during exercise and overnight.
Sputum examination. Analysis of cells in sputum can help determine the cause of some lung problems.
Computerized tomography (CT) scan. A CT scan allows your doctor to see your organs in two-dimensional images or "slices." Split-second computer processing creates these images as a series of very thin X-ray beams are passed through your body. A CT scan can detect emphysema sooner than an ordinary chest X-ray can, but it can't assess the severity of emphysema as accurately as can a pulmonary function test.

Additionally, researchers are studying whether magnetic resonance imaging (MRI) could detect emphysema even before signs and symptoms appear.
Treatment

The most important step in any treatment plan for smokers with emphysema is stopping smoking; it's the only way to stop the damage to your lungs from becoming worse. But quitting is never easy, and people often need the help of a comprehensive smokingcessation plan, which may include:
A target date to quit
Relapse prevention
Advice for healthy lifestyle changes
Social support systems
Medications, such as nicotine gum or patches and the prescription medications bupropion hydrochloride (Zyban) and varenicline (Chantix)

Nicotine replacement products and prescription medications may help curb the irritability, depression and sleep problems that can occur during the first few weeks after quitting smoking.

Other emphysema treatments, which focus on relieving symptoms and preventing complications, include:
Bronchodilators. These drugs can help relieve coughing, shortness of breath and trouble breathing by opening constricted airways, but they're not as effective in treating emphysema as they are in treating asthma.
Inhaled steroids. Corticosteroid drugs inhaled as aerosol sprays may relieve symptoms of emphysema associated with asthma and bronchitis. Although inhaled steroids have fewer side effects than oral steroids do, prolonged use can weaken your bones and increase your risk of high blood pressure, cataracts and diabetes.
Supplemental oxygen. If you have severe emphysema with low blood oxygen levels, using oxygen at home may provide some relief. Various forms of oxygen are available as well as different devices to deliver them to your lungs. Talk with your doctor about which is best for you and about oxygen distributors in your area. Your dealer can set up your equipment, instruct you on care and maintenance, and provide follow-up visits.
Protein therapy. Infusions of AAt may help slow lung damage in people with an inherited deficiency of the protein.
Antibiotics. Respiratory infections such as acute bronchitis, pneumonia and influenza are a leading complication of emphysema; infections increase the amount of sputum you produce and make breathing problems worse. Broad-spectrum antibiotics may help relieve these symptoms, but should be used with caution to avoid the serious and growing problem of antibiotic-resistant bacteria.
Inoculations against influenza and pneumonia. If you have emphysema or other forms of COPD, experts recommend an influenza (flu) shot annually and a pneumonia shot every five years after age 65.

Surgery. In a procedure called lung volume reduction surgery (LVRS), surgeons remove small wedges of damaged lung tissue. Although it seems counterintuitive to treat diminished lung capacity by further reducing the size of the lungs, the extra space that's created in the chest cavity appears to help the remaining lung tissue and diaphragm work more efficiently.

A large clinical trial called the National Emphysema Treatment Trial showed that LVRS could improve the lung function of certain people with severe emphysema. Those who benefited had emphysema in the upper lobes of their lungs and a low exercise capacity even after undergoing several weeks of pulmonary rehabilitation.

Improvement in lung function was greatest the first six months after the procedure. After that, lung function gradually declined. By the two-year mark, the lung function in many people was about the same as it was before surgery. If you have severe emphysema and think you may be a candidate for LVRS, discuss the risks and benefits of the operation with your doctor.
Transplant. Lung transplantation is an option if you have severe emphysema and other options have failed.

Pulmonary rehabilitation program. A key part of treatment involves a pulmonary rehabilitation program, which combines education, exercise training and behavioral intervention to help restore you to the highest possible level of independent living.

You'll receive help with smoking cessation and your nutritional needs, and you may learn special breathing techniques and ways to conserve energy. You'll also be given an exercise program that's appropriate for you. This may include aerobic exercises, such as walking and riding an exercise bike, as well as special exercises for your arms and legs.
Prevention

Most cases of emphysema are due to smoking. If you smoke — cigarettes, cigars or a pipe — your chance of developing emphysema is much greater than for nonsmokers. The best way to prevent emphysema is to not smoke or to stop smoking as soon as possible. In addition, try to limit your exposure to secondhand smoke.

Although smoking is the most common cause of emphysema, occupational exposure to chemical fumes and dust also is a risk factor. Try wearing a dust mask for protection if you work in such an environment.
Self-care

Some simple exercises can improve your breathing if you have emphysema or another chronic lung disorder. They help you control the emptying of your lungs by using your abdominal muscles. Do them two to four times daily.

Diaphragmatic breathing
To perform this type of breathing exercise, take these steps:
Lie on your back with your head and knees supported by pillows. Begin by breathing in and out slowly and smoothly in a rhythmic pattern. Relax.
Place your fingertips on your abdomen, just below the base of your rib cage. As you inhale slowly, you should feel your diaphragm lifting your hand.
Practice pushing your abdomen against your hand as your chest becomes filled with air. Make sure your chest remains motionless. Try this while inhaling through your mouth and counting slowly to three. Then purse your lips and exhale through your mouth while counting slowly to six.

Practice diaphragmatic breathing on your back until you can take 10 to 15 consecutive breaths in one session without tiring. Then practice it while lying on one side and then on the other. Progress to doing the exercise while sitting erect in a chair, standing up, walking and, finally, climbing stairs.

Pursed-lip breathing
Try the diaphragmatic breathing exercises with your lips pursed as you exhale, that is, with your lips puckered — the flow of air should make a soft "sssss" sound. Inhale deeply through your nose or your mouth, whichever is more comfortable for you, and then exhale. Repeat 10 times at each session. Breathing out against pursed lips increases the air pressure inside the airways, including your very small airways, which minimizes how much they collapse.

Deep-breathing exercise
While sitting or standing, pull your elbows firmly backward as you inhale deeply. Hold the breath in, with your chest arched, for a count to five, and then force the air out by contracting your abdominal muscles and letting your elbows to return to their starting position. Repeat the exercise 10 times.

Other steps you can take
If you have emphysema, you can take a number of steps to halt its progression and to protect yourself from complications:
Stop smoking. This is the most important measure you can take for your overall health and the only one that can halt the progression of emphysema. Join a smoking cessation program if you need help giving up smoking. As much as possible, avoid secondhand smoke. Sit in nonsmoking areas when you're out, and ask family and friends not to smoke in your home.
Avoid other respiratory irritants. These include fumes from paint and automobile exhaust, some cooking odors, certain perfumes, even burning candles and incense. Change furnace and air conditioner filters regularly to limit pollutants.
Exercise regularly. Try not to let your breathing problems keep you from getting regular exercise, which can significantly increase your capacity for physical activity.
Clear your airways. With emphysema, mucus tends to collect in your air passages and can be difficult to clear. To keep secretions thin and easy to bring up, drink plenty of nonalcoholic fluids every day.
Protect yourself from cold air. During cold weather wear a soft scarf or a cold-air mask — available from a pharmacy — over your mouth and nose to warm the air that's entering your lungs. You need to put the face mask on before you go out into the cold. For the same reason, breathe through your nose because cold air can cause spasms of the bronchial passages.
Avoid respiratory infections. Get a pneumonia vaccination as advised by your doctor and an annual influenza immunization. Do your best to avoid direct contact with people who have a cold or the flu. If you have to mingle with large groups of people during cold and flu season, wash your hands frequently and carry a small bottle of hand sanitizer in your pocket or purse. Try to avoid touching the inside of your nose or rubbing your eyes, which is the way you acquire most viral infections. If you must be in crowds during colds and flu season, wear a face mask.

Maintain good nutrition. A balanced diet gives your body the nutrients it needs for energy, for building and maintaining cells, and for regulating body processes. Work toward and maintain a desirable body weight. Being overweight requires more oxygen and can interfere with breathing. If you're underweight, achieving a healthy weight may increase your strength.

When the effort to eat is taxing, you may need to eat smaller meals more frequently. Some people are helped by eating their larger meal earlier in the day and avoiding lying down after meals. Choosing soft, easy-to-digest foods, such as yogurt, rice, baked potatoes, and poached chicken or fish, also may help.
Coping skills

These suggestions may help you cope with having emphysema:
Express your feelings. Having emphysema may cause a gradual change in your lifestyle and that of your family. Share your feelings and concerns about your disease with your family, friends and doctor. Be alert to changes in your mood and your relations with others. Living with emphysema can be difficult. Don't be afraid to seek counseling if you feel depressed or overwhelmed.
Consider a support group. You may also want to consider joining a support group for people with emphysema. Although support groups aren't for everyone, they can be a good source of information about new treatments and coping strategies. And it can be encouraging to be around other people who are meeting the same challenges you are. If you're interested in a support group, talk to your doctor. Or, contact your local chapter of the American Lung Association.

By Mayo Clinic Staff
Dec 15, 2007

Chronic Bronchitis Disease Information

Bronchitis is an inflammation (or irritation) of the airways in the lungs. Airways are the tubes in your lungs that air passes through. They are also called bronchial tubes. When the airways are irritated, thick mucus forms in them. The mucus plugs up the airways and makes it hard for air to get into your lungs. Symptoms of bronchitis include a cough that produces mucus (sometimes called sputum), trouble breathing and a feeling of tightness in your chest.

"Chronic" means that the condition last a long time. Chronic bronchitis is bronchitis that lasts longer than 3 months. Chronic bronchitis often occurs with emphysema, and together these diseases are called chronic obstructive pulmonary disease (COPD).


What causes chronic bronchitis?
Cigarette smoking is the main cause of chronic bronchitis. When tobacco smoke is inhaled into the lungs, it irritates the airways and they produce mucus. People who have been exposed for a long time to other things that irritate their lungs, such as chemical fumes, dust and other substances, can also develop chronic bronchitis.


How does my doctor know if I have chronic bronchitis?
Your doctor will ask you about your symptoms: Are you coughing up mucus? Are you having trouble breathing? Does your chest feel tight? How long have you had these symptoms? Do you smoke cigarettes? How many cigarettes do you smoke each day? How many years have you been smoking? Have you been breathing in other things that can irritate your lungs?

If your doctor thinks you have chronic bronchitis, you may be tested to find out if your lungs are damaged. You might have a pulmonary function test to see how well your lungs are working. During this test, you breathe into a machine that measures the amount of air in your lungs. Your doctor may also order blood tests and a chest X-ray.

What can I do to help my breathing and reduce my coughing?
If you smoke, the most important thing you can do is to stop. The more smoke you breathe in, the more it damages your lungs. If you stop smoking, you'll breathe better, you won't cough as much and your lungs will begin to heal. You'll also reduce your chance of getting lung cancer. Ask your doctor to help you stop smoking.

Try to avoid other things that can irritate your lungs, such as aerosol products like hairspray, spray deodorant and spray paint. Also avoid breathing in dust or chemical fumes. To protect your lungs, wear a mask over your nose and mouth if you are using paint, paint remover, varnish or anything else with strong fumes.


Can medicine treat chronic bronchitis?
Yes. Your doctor may prescribe a medicine called a bronchodilator to treat your chronic bronchitis. This medicine dilates (or opens) the airways in your lungs and helps you breathe better.

This medicine is usually inhaled (breathed in) rather than taken as a pill. An inhaler is the device used to get the medicine into your lungs. It's important to use your inhaler the right way, so you get the most from the medicine. Your doctor will show you how to use your inhaler.

If you have severe shortness of breath, your doctor may also prescribe medicine (such as theophylline) for you to take in pill form.

If your symptoms don't get better with these medicines, your doctor may prescribe steroids. You can take steroids either with an inhaler or in pill form.

Will antibiotics help chronic bronchitis?
In general, antibiotics cannot help chronic bronchitis. Antibiotics may be needed if you get a lung infection along with your chronic bronchitis. If you have a lung infection, you may cough up more mucus. This mucus might be yellow or dark green. You also may have a fever and your shortness of breath may get worse.

Because chronic bronchitis increases your risk of lung infections, be sure to get a flu shot every year. Also, get a pneumococcal vaccination every 5 to 6 years to protect against pneumonia.


A note about vaccines
Sometimes the amount of a certain vaccine cannot keep up with the number of people who need it. More info...


What about oxygen therapy?
Because of the damage from chronic bronchitis, your lungs may not be able to get enough oxygen into your body. Your doctor may prescribe oxygen if your chronic bronchitis is severe and medicine doesn't help you feel better. If your doctor prescribes oxygen for you, be sure to use it day and night to get the most benefit from it. Oxygen can help you breathe better and live longer.

What else can I do to help my lungs?
Exercising regularly can strengthen the muscles that help you breathe. Try to exercise at least 3 times a week. Start by exercising slowly and for just a little while. Then slowly increase the time you exercise each day and how fast you exercise. For example, you might begin exercising by walking slowly for 15 minutes 3 times a week. Then, as you get in better shape, you can increase your walking speed. You can also increase the length of time you walk to 20 minutes, then 25 minutes, then 30 minutes. Ask your doctor for help creating an exercise plan that's right for you.

An exercise program called pulmonary rehabilitation may help you improve your breathing. Pulmonary rehabilitation is often given by a respiratory therapist (a health care worker who knows about lung treatments). Your doctor may refer you to the pulmonary rehabilitation program at your local hospital.

A breathing method called "pursed-lip breathing" may also help you. To do this, you take a deep breath and then breathe out slowly through your mouth while you hold your lips as if you're going to kiss someone. Pursed-lip breathing slows down the fast breathing that often comes with chronic bronchitis. It may help you feel better.