Category: Blog

What Is a Lung Nodule? Symptoms, Causes, and When You Should Worry

A lung nodule is a small, round, or oval growth in the lung, usually detected during imaging tests such as a chest X-ray or a CT scan. The discovery of a nodule can be quite alarming but not all of them are cancerous. Some are benign and require minimal intervention, while other nodules may require further evaluation by an asthma doctor in Singapore. While asthma itself does not necessarily lead to the formation of lung nodules, certain conditions associated with asthma can do so. Some nodules are a sign of something serious, like infections, inflammation, or even early-stage lung cancer. Understanding the potential causes, symptoms, and risks associated with lung nodules can assist individuals in making informed decisions about their respiratory health. 

Common Causes of Lung Nodules 

These nodules can develop owing to a multitude of factors, such as: 

  • Infectious Granulomas: Granulomas are clusters of immune cells that are the most common type of benign nodules. Fungal lung infections or tuberculosis can cause granulomas to form. 
  • Non-Infectious Granulomas: Autoimmune diseases like rheumatoid arthritis and sarcoidosis can lead to the formation of non-infectious granulomas. 
  • Benign Tumours: These typically include hamartomas, lipomas, and adenomas. 
  • Cancerous Tumours: A common cause of pulmonary nodules includes non-small cell lung cancer, small cell lung cancer, and carcinoid tumours. 
  • Fibrotic Scarring: Smoking or inhaling lung irritants or chemicals can lead to lung scarring, which causes nodules. 

What Indicates the Presence of a Lung Nodule? 

Most nodules do not cause noticeable symptoms, making early detection a bit difficult. However, in cases where symptoms appear, they may include: 

  • Persistent coughing that lasts a few weeks 
  • Shortness of breath or difficulty breathing 
  • Wheezing 
  • Chest pain that becomes worse with deep breathing or coughing 
  • Coughing up blood (haemoptysis) 
  • Hoarseness 
  • Frequent respiratory infections such as bronchitis or pneumonia 
  • Unexplained weight loss 
  • Fatigue 

When Should You See a Specialist? 

Although most lung nodules are generally harmless, there are certain factors that necessitate immediate evaluation by a doctor, such as: 

  • History of smoking 
  • Prolonged exposure to harmful chemicals 
  • Family history of lung cancer 
  • The nodule having irregular borders 
  • The nodule growing over time 
  • Chronic cough 
  • Chest pain 

Early detection and assessment by an asthma specialist in Singapore can help determine the next course of action including a suitable treatment plan and effective lifestyle changes. 

Diagnosis and Testing 

When a lung nodule is detected, the specialist may order a series of tests, which include: 

  • CT Scan: This imaging test provides detailed images of the nodule to assess its size, composition, and shape. 
  • PET Scan: This test helps determine whether the nodule is active, which can indicate potential malignancy. 
  • Sputum Cytology: A sputum cytology test involves examining mucus under a microscope to look for abnormal or cancerous cells. 
  • Bronchoscopy: A thin, flexible tube with a camera is inserted into the airways to collect tissue samples for an analysis. 
  • Needle Biopsy: A needle is used to extract tissue from the nodule. 

Suitable Treatment Options 

The treatment approach for lung nodules may differ, depending on the nodule’s size, nature, and potential malignancy. Treatment options typically include: 

  • Surveillance: Active surveillance, also known as watchful waiting, refers to keeping a close watch on  the nodule to see if it grows or changes with time. 
  • Surgery: This is not required for benign lung nodules, but if a patient has symptoms such as coughing or difficulty in breathing, a specialist may order a biopsy to ascertain what’s causing the development of the nodule. If the test shows that the nodule is cancerous, it can be surgically removed. 

Other treatment options for cancerous lung nodules include chemotherapy or radiation therapy. 

Consult an Asthma Doctor in Singapore

Although the discovery of a lung nodule can be quite unsettling, they are benign most of the time, depending on the patient’s specific risk factors. If the patient is at risk, however, they should consult a specialist for evaluation, management, and treatment if necessary. 

If you or a loved one is experiencing symptoms of a lung nodule, it’s necessary to schedule a consultation with an asthma specialist in Singapore at Philip Eng Respiratory and Medical Clinic. We specialise in the evaluation and diagnosis of a range of lung conditions, to provide evidence-based treatment while prioritising patient comfort and care in a private setting. Led by Dr. Philip Eng, our areas of specialisation include asthma, coughing, wheezing, haemoptysis, and Chronic Obstructive Pulmonary Disease (COPD), emphysema, pneumonia, and suspected lung cancer, among others. 

Please feel free to get in touch with us for a consultation. We can be contacted via phone at (+65) 6836 0378 for general enquiries and appointments, or (+65) 6535 8833 for 24-hour answering service. Alternatively, you may email us at drphilipeng@singnet.com.sg or fill out a message form here.

Lung Infections: How a Lung Infection Specialist Can Help

Ranging from mild cases of the flu to serious conditions like pneumonia, lung infections can significantly impact respiratory health. Prevention of lung infections is especially necessary for individuals who are prone to complications, such as heavy smokers, the elderly, and those with pre-existing complications such as Chronic Obstructive Pulmonary Disease (COPD). It’s essential to understand how to protect yourself from lung infections to reduce the risk of contracting an illness and enhance overall well-being. Whether through important vaccinations, necessary lifestyle changes, or early detection, taking proactive measures can safeguard your lungs and help ease your breathing. If you are at risk or experiencing symptoms, consulting a lung infection specialist is recommended, to receive appropriate care and treatment. 

How Vaccinations Can Help Prevent Lung Infections 

An effective way to prevent yourself from contracting a lung infection is through vaccinations. Vaccines help the immune system recognise and fight infections before they become severe. The following immunisations are especially important: 

  • Pneumococcal Vaccine: This vaccine protects against pneumococcal diseases such as pneumonia, bacterial meningitis, and bloodstream infections. A pneumonia specialist in Singapore may recommend this vaccine for high-risk individuals, including older adults and those with weakened immune systems.
  • Influenza Vaccine: The flu can lead to severe respiratory complications and an annual flu shot can help reduce the risk of contracting an infection and lower the severity of symptoms. 
  • COVID-19 Vaccine: COVID-19 can cause severe respiratory issues, making the vaccine crucial to avoid hospitalisation and complications, especially in high-risk individuals such as those who already have COPD or other existing lung infections. 

Updated vaccines are a simple yet effective way to reduce the risk of contracting a lung infection and other related complications. If you or a loved one has an underlying respiratory condition, a lung infection specialist can advise a suitable vaccine to prevent a lung infection from occurring. 

Enhancing Lung Health: Necessary Lifestyle Changes 

A strong immune system and healthy lungs can significantly lower the risk of respiratory infections and adopting some necessary lifestyle habits can help, such as: 

  • Maintain an Active Lifestyle: Regular physical activity and exercise can enhance lung capacity and circulation, which helps the immune system effectively fight off infections. 
  • Quit Smoking: Smoking weakens the lungs, damages airways, and increases susceptibility to pneumonia and bronchitis, in addition to increasing the risk of developing chronic respiratory diseases. 
  • Practice Good Hygiene: Frequent handwashing, keeping away from sick individuals, and wearing a mask in crowded areas or areas with poor air quality can prevent the spread of airborne pathogens. 
  • Stay Hydrated: Drinking plenty of water can help keep the respiratory tract moist and help reduce mucus production, making it easier to clear potential infections. 
  • Maintain a Healthy Diet: A balanced diet rich in vitamins and antioxidants supports the immune system and helps the body fight infections. 

Recognising Early Signs and Knowing When to Seek Medical Attention 

Early detection of a lung infection can prevent complications and assist in recovery. Some warning signs include: 

  • Persistent cough with or without mucus 
  • Shortness of breath or any difficulty breathing 
  • Wheezing when breathing 
  • Chest pain or discomfort 
  • Fever, chills, and body aches 
  • Fatigue 
  • Loss of appetite 

If symptoms worsen or persist for more than a few days, it may be time to consult a lung infection specialist. Those with conditions such as COPD should be vigilant because lung infections can exacerbate their symptoms and lead to severe complications. A specialist can order chest X-rays or lung function assessments to determine the cause of symptoms and provide targeted COPD treatment or other infection management tips. 

Who’s At Risk? 

Those at high risk of contracting a lung infection include: 

  • Elderly Individuals: Ageing weakens the immune system, making older adults or the elderly more vulnerable to pneumonia, the flu, and other respiratory infections. Routine checkups with a specialist can help prevent serious complications from occurring. 
  • Immunocompromised Individuals: People with weakened immune systems owing to diabetes, HIV, or most cancer treatments such as chemotherapy and some forms of radiation therapy, should be cautious. Necessary vaccinations, early medical intervention, and lifestyle changes are critical for their health. 
  • Frequent Smokers and COPD Patients: Smoking-related lung damage and conditions such as COPD make individuals more susceptible to infections. Seeking timely treatment for COPD and quitting smoking can enhance lung function and reduce the risk of complications. 

Schedule a Consultation With a Pneumonia Specialist in Singapore

If you have concerns about your respiratory health or need specialised advice, consult a pneumonia specialist in Singapore at Philip Eng Respiratory and Medical Clinic. Led by Dr. Philip Eng, our team can provide comprehensive care and tailored advice for your respiratory issues, ensuring that your lungs stay healthy and free of infections. 

Our clinic is conveniently located at Mount Elizabeth Medical Centre, and we can be contacted on (+65) 6836 0378 for appointments and (+65) 6535 8833 for round-the-clock inquiries.

When to See a Pulmonologist in Singapore? Signs You Shouldn’t Ignore

Breathing is one of the most fundamental things in life, and yet, we take it for granted, not knowing when we will be faced with respiratory issues. The human respiratory system plays a vital role in ensuring that the body receives enough oxygen to function optimally. However, respiratory issues can sometimes be overlooked, with symptoms mistaken for a common cold or cough. A pulmonologist specialises in diagnosing and treating conditions that affect the lungs and respiratory system. Whether it’s a persistent cough or a chronic lung disease, these specialists help patients to breathe better and live a more comfortable life when it comes to breathing. But, when should you consult a pulmonary specialist? This blog article delves into the warning signs experienced by those with debilitating respiratory conditions and when they should consult a pulmonologist in Singapore. 

Warning Signs of Poor Respiratory Health 

  • Persistent Cough and Shortness of Breath 

A cough is a natural reflex of the body that helps clear the airway, but when it becomes persistent and lasts more than a few weeks, it could be a sign of a serious underlying issue. Consulting a chronic cough specialist can provide an accurate evaluation of symptoms and diagnosis, to check whether it’s arising from asthma, chronic bronchitis, or even a lung infection. 

Shortness of breath, also referred to as dyspnea, is another concerning symptom that should not be ignored. While occasional breathlessness after physical exertion is normal, struggling to breathe during routine activities, such as walking up the stairs, might be a sign of a more serious respiratory problem. Conditions like chronic obstructive pulmonary disease (COPD) or interstitial lung disease could be the cause of dyspnea, and consulting a pulmonologist can help identify the root cause and provide suitable treatment. 

  • Chronic Respiratory Conditions

Those diagnosed with chronic respiratory diseases such as asthma or COPD require ongoing medical supervision as these conditions progressively worsen with time, leading to complications that significantly hinder daily activities. Those diagnosed with asthma may experience constant wheezing, chest tightness, and nighttime coughing. When these symptoms become difficult to control with standard inhalers or medication, a pulmonary specialist can recommend other treatment options to enhance lung function. A chronic cough specialist in Singapore can help manage symptoms effectively with a personalised treatment plan in addition to medication and lifestyle adjustments, where necessary. 

  • Sleep-Related Breathing Disorders 

Breathing difficulties during sleep can have a significant impact on overall health. Obstructive sleep apnea (OSA) is one of the most common sleep-related breathing disorders, which involves repeated interruptions in breathing throughout the night. People with OSA often experience loud snoring, choking episodes during sleep, and excessive daytime fatigue. 

When this is left untreated, sleep apnea can contribute to high blood pressure, heart disease, and an increased risk of stroke. A pulmonologist can effectively diagnose the condition and recommend appropriate treatments such as continuous positive airway pressure (CPAP) therapy or other treatment options to help restore healthy breathing patterns. 

  • Frequent Lung Infections 

Recurring lung infections, such as pneumonia or bronchitis, may be a sign of an underlying respiratory issue. While occasional infections are common, frequent or severe infections could be an indication of a weakened immune system or chronic lung disease. Lung infections that do not resolve with standard treatments may be connected to conditions such as bronchiectasis, where the airways become permanently widened and prone to infection. 

Early diagnosis and appropriate treatment by a specialist can help prevent further complications and enhance lung health. Those who experience recurrent bouts of pneumonia, prolonged chest congestion, or difficulty recovering from respiratory illnesses should seek immediate medical attention from a chronic cough specialist in Singapore. 

Preparing for a Consultation with a Pulmonologist

Before preparing for an appointment with a pulmonologist in Singapore, do take note of the following: 

  • List Your Medical History: Keep a notebook or list of your medical history, including past and current medical conditions, surgeries, and any respiratory issues you’ve had, including treatment and efficacy. 
  • Keep Track of Symptoms: Be sure to write down any respiratory symptoms you’ve been experiencing so you can list these out to the doctor, as they can help with accurate diagnosis and prescribe appropriate treatment. 
  • Allergies: Don’t forget to tell your doctor if you’re allergic to any type of medication, so they can refrain from prescribing it. 
  • Avoid Caffeine Before: Keep away from caffeine or any other beverage that increases mucus production such as juices, milkshakes, or even alcohol. Drink as much water as possible. 
  • Bring Previous Test Results: If you have any previously done test results, bring them along to show the doctor. This includes X-rays, CT scans, lung function tests, or bloodwork related to your respiratory health. 
  • Write Down Questions: Prepare a list of concerns you want to discuss, such as: 
      • What could be causing my symptoms?
      • What tests do I need?
      • What treatment options are available?
      • How can I prevent my condition from worsening?

Consult a Chronic Cough Specialist in Singapore at Philip Eng Respiratory and Medical Clinic

If you or a loved one are experiencing any of these symptoms, it’s recommended to seek immediate medical attention to keep from worsening your condition. Schedule an appointment with Philip Eng Respiratory and Medical Clinic today. Their team, led by Dr. Philip Eng can diagnose and treat a wide range of respiratory conditions, ensuring that you receive suitable care and treatment. Please don’t hesitate to get in touch with us to schedule a consultation with a pulmonologist in Singapore today!

When Should You See a Lung Cancer Specialist in Singapore? Recognising the Warning Signs

Lung cancer remains one of the most common and serious types of cancer worldwide. In Singapore, lung cancer is the third most common type of cancer in males and females respectively, with it being the leading cause of cancer-related deaths for both genders. Early detection is crucial in ensuring favourable treatment outcomes and survival rates. Many symptoms of lung cancer generally go unnoticed or can be mistaken for minor respiratory issues, which is why it’s important to understand the warning signs. If you or a loved one is experiencing persistent respiratory issues, it may be time to schedule an appointment with a lung cancer specialist in Singapore. This blog article discusses common symptoms of lung cancer, risk factors, and how to prepare for an appointment. 

Common Symptoms of Lung Cancer 

Symptoms of lung cancer vary, depending on the stage and type of cancer. Here are some key signs that should not be ignored: 

  • Persistent Cough: A cough that lingers for more than a few weeks, especially if it worsens or ends up with the patient coughing up blood, is an immediate cause of concern. 
  • Shortness of Breath: Difficulty in breathing could be a major sign of lung impairment. 
  • Chest Pain: Discomfort or pain in the chest that worsens with deep breathing, coughing, or laughing, can be a symptom. 
  • Unexplained Weight Loss: Losing weight without a change in diet or exercise could be a sign of lung cancer. 
  • Constant Fatigue: Persistent exhaustion that does not seem to go away with adequate rest or sleep could be an indicator of an underlying condition. 
  • Throat Hoarseness: Changes in voice tone or persistent hoarseness in the throat is a lesser-known symptom of lung cancer. 
  • Frequent Respiratory Infections: Recurring bronchitis or pneumonia could indicate an underlying lung condition. 

If you experience any of the above symptoms, it’s essential to consult a lung specialist in Singapore for further evaluation, diagnosis and treatment. 

Risk Factors to Consider 

Certain factors increase the likelihood of developing lung cancer, such as: 

  • Smoking: This is the leading cause of lung cancer and significantly increases the risk of developing it. This applies to those who are secondhand smokers as well. 
  • Exposure to Carcinogens: Exposure to radon, asbestos, arsenic, and diesel exhaust increases the risk of lung cancer. 
  • Family History: If close relatives have had lung cancer, then genetic predisposition may be a contributing factor. 
  • Air Pollution: Long-term exposure to polluted environments may contribute to lung cancer development. 
  • Chronic Lung Diseases: Certain conditions such as Chronic Obstructive Pulmonary Disease (COPD) or pulmonary fibrosis can increase the risk of developing lung cancer. 

Understanding these risk factors in detail helps make an informed decision regarding lifestyle changes and cancer screenings. If you belong to a high-risk group, it’s advisable to make an appointment with a lung specialist for an early screening. 

Preparing for an Appointment with a Lung Specialist in Singapore 

Before scheduling an appointment with a lung specialist, keep note of the following: 

  • Listing Symptoms: Write down any persistent symptoms, their frequency, and severity. 
  • Medical History: Keep note of any past respiratory conditions, exposure to risk factors, and family history of lung disease. 
  • Medications and Supplements: Provide a list of any medications or supplements you take. 
  • Questions to Ask: Prepare questions about symptoms, possible causes, diagnostic tests, and treatment options. 

Being well-prepared ensures that your consultation is thorough and informative, allowing your lung cancer specialist to assess your condition properly. 

Screening and Diagnosis 

Lung cancer screening and diagnosis typically involve various tests to determine the presence and stage of cancer. A lung specialist in Singapore may recommend or order the following tests, which include: 

  • Low-Dose CT Scan (LDCT): This imaging test detects lung abnormalities and is commonly used for high-risk individuals. 
  • Chest X-ray: This is a preliminary test done to identify abnormalities in lung structure. 
  • Sputum Cytology: This test involves an examination of coughed-up mucus to detect cancer cells. 
  • Biopsy: A biopsy involves extracting a sample of lung tissue for laboratory testing to confirm malignancy. 
  • Bronchoscopy: A thin tube with a camera is inserted into the airways for closer examination. 
  • PET Scan: Helps in determining cancer spread to other parts of the body. 

Early detection through these tests allows for effective treatment, potentially allowing favourable survival rates. If lung cancer is diagnosed, the doctor will discuss tailored treatment plans, which may include surgery, chemotherapy, radiation therapy, or targeted therapy. 

Consult a Lung Cancer Specialist in Singapore at Philip Eng Respiratory and Medical Clinic 

If you experience persistent respiratory issues or fall into a high-risk category, seeking medical advice is essential to prevent any potential complications from occurring if left ignored or untreated. Consulting a lung specialist in Singapore ensures a proper evaluation and access to necessary diagnostic and treatment options. 

For expert lung care, consider scheduling an appointment at Philip Eng Respiratory and Medical Clinic, where our team, under the guidance of Dr. Philip Eng, provides comprehensive assessments and personalised treatment plans. Early intervention can make all the difference, so don’t hesitate to schedule an appointment today. Our clinic is conveniently located at Mount Elizabeth Medical Centre and we are contactable via phone at (+65) 6836 0378 or via email at drphilipeng@singnet.com.sg.

Is It Pneumonia or Bronchitis? How To Tell Them Apart

Anybody who has had a cold knows how nasty it can get. You might have woken up with a scratchy throat and a stuffy nose, or maybe you are not feeling too well, and your body feels slightly achy. You may even have a fever and cough to deal with. But what if these symptoms don’t go away as you assumed they would? What if it’s not just a common cold and it’s something more serious like pneumonia? How can you tell? Bronchitis or pneumonia share similar symptoms, making it hard to differentiate between them. If your symptoms persist, it is highly advisable to seek the advice and an evaluation by a respiratory specialist. 

Exploring the main causes and symptoms of bronchitis and pneumonia: Understanding the similarities and differences

Bronchitis

This respiratory condition occurs when the bronchi, the tubes that carry air into your lungs, get inflamed. Bronchitis usually occurs following a viral infection. Although both bronchitis and pneumonia are often associated with a cough and fever, the fever that comes with bronchitis is usually milder than in pneumonia. Moreover, while pneumonia develops in your lung tissues and gets worse, bronchitis is confined to the bronchial tubes. Other symptoms of bronchitis include cough or chest pain.

There are two forms of bronchitis: acute and chronic bronchitis. Acute bronchitis occurs suddenly, usually does not last more than a week and seldom recurs. Patients with acute bronchitis often present with a cough with or without sputum. Chronic bronchitis, on the other hand, is a form of COPD (chronic obstructive pulmonary disease) that occurs due to long-term inflammation of the breathing tubes. Smoking is the main cause of this disease and chronic bronchitis is characterised by a chronic productive cough and shortness of breath.

Pneumonia

This respiratory infection develops when the lungs become inflamed, affecting one or both lungs. While anybody can get infected with pneumonia, babies and older adults are at a higher risk of getting seriously ill. In addition, patients with cardiac and other lung conditions like cancer may also be at risk of getting pneumonia. Symptoms may range from mild to serious and may include fever, cough, and breathing difficulties. Bacteria, viruses, and fungi can cause pneumonia and are commonly spread by coughing or sneezing. 

Bacteria are the most common cause of pneumonia, and patients often present with a cough that produces thick, yellowish-green sputum with pus. Viral pneumonia is usually mild and comes with symptoms such as fever, dry cough and sore throat. Fungal pneumonia normally occurs in those who have chronic health conditions or a weak immune system such as patients with HIV. This occurs when fungal spores mix with the air we inhale or by the reactivation of a latent infection.

Uncovering the diagnostic and treatment options of bronchitis and pneumonia: Understanding how the conditions are managed

pneumonia

Bronchitis is diagnosed with the help of a detailed medical history and physical examination. In most cases, additional investigations are not required. Some physicians may order a chest X-ray to rule out pneumonia, especially if the patient is very sick. Diagnosing pneumonia can be challenging as the symptoms are often similar to those of a common cold or flu. Therefore, in addition to reviewing your medical history and carrying out a physical examination, your pulmonologist may order a number of tests, including blood tests, chest X-rays and sputum tests. If a patient is in the high-risk group, they may also have to undergo some additional tests like a CT scan, arterial blood gases, bronchoscopy, and a pleural fluid culture.

Most patients with acute bronchitis may not need any treatment as the condition usually resolves on its own. But antibiotics may be needed if it’s bacterial. For chronic bronchitis, the condition results in lung damage and cannot be reversed. If you are a smoker and you quit this habit, the rate of decline will reduce significantly. Bronchodilators are provided to relieve symptoms and relax the airways, while anti-inflammatory drugs may be given to reduce the swelling of the airway passages. Those who have low blood oxygen levels due to lung damage will benefit from oxygen therapy.

Treatment for pneumonia will vary depending on the type of pneumonia and other factors like the patient’s age, health condition, and the severity of the disease. The aim of treatment is to cure the infection and prevent any complications from occurring. Antibiotics will be required for bacterial pneumonia, but if the patient has viral pneumonia, antiviral medication will be prescribed. Antifungal medication will be used in the treatment of fungal pneumonia. If you have mild pneumonia, it can be managed at home, but if the disease is severe, hospitalisation may be required and intravenous fluids, antibiotics, oxygen therapy, and other treatments may be given.

Diving deeper into bronchitis and pneumonia: Can bronchitis turn into pneumonia?

Although both these conditions share many similarities, they are different diseases. Bronchitis usually resolves well with or without treatment while patients with pneumonia need to be treated and followed-up. Those who are at risk of experiencing complications from pneumonia are babies, older adults, and individuals with underlying health conditions and/or a weakened immune system. Therefore, prompt treatment of pneumonia is crucial to prevent complications and a bad outcome.

What Are The Warning Signs and Symptoms of Asthma?

The lungs play a crucial role in gas exchange, helping us to breathe. Located in the chest cavity, they lie on either side of the mediastinum, which is the central compartment that holds the heart as well as other structures. Although both lungs look similar, the left lung is slightly smaller and has two lobes, while the right one has three and is enveloped by a protective layer known as pleural tissue. They are also connected to the windpipe (trachea) by the bronchi, which are large muscular tubes that branch into smaller tubes known as bronchioles with tiny hollow cup-shaped air sacs called alveoli at the end of these tubes.

 These structures, along with the nasal cavity and other breathing muscles, help keep us alive by allowing us to extract oxygen while expelling carbon dioxide. Respiratory conditions like asthma can wreak havoc on this process, resulting in breathing difficulties. This article will explore the intricacies of this respiratory disease, providing a closer look at the warning signs and other essential information.

What is asthma?

Asthma is a chronic lung disease in which the airways narrow and swell, making it difficult to breathe. This inflammatory condition can also block the airways due to excess mucus production, causing a range of symptoms from coughing,  wheezing, shortness of breath or chest pain. Asthma is a very common condition affecting many individuals worldwide and can appear at any stage in life. All around the world, about 5% of adults are diagnosed with this condition, and about 20% of children, making it important to consult a pulmonologist (respiratory specialist) to receive the appropriate treatment. 

What is an asthma attack, and what are the early warning signs? 

Asthma can vary in severity, and can affect the daily activities of people and even result in life-threatening asthma attacks and death. An asthma attack is the sudden worsening of asthma symptoms brought on by the sudden narrowing of the muscles of your airways. This rapid muscle contraction can make breathing challenging, and this is what triggers the attack. Mild attacks are usually more common and typically resolve within a short time, but severe attacks, although rare, can last longer, requiring medical attention. Being able to recognise the early signs and triggers will go a long way in preventing a severe episode.

Let’s walk through the most common triggers of asthma:

  • Infections (e.g. colds and flu)
  • Allergies (e.g. pollen and animals)
  • Exercise (rare cases)
  • Pests (e.g. cockroaches)
  • Animal dander (cats, dogs and birds)
  • Dust mites
  • Tobacco smoke
  • Air pollution
  • Certain medications (e.g. ibuprofen and aspirin)
  • Certain foods and fragrances
  • Acid reflux
  • Climate changes eg humidity
  • Strong emotions (as a result of hyperventilation)

asthma

Here are some early warning signs that may indicate your condition is worsening:

  • Persistent cough (especially at night)
  • Runny, stuffy, or congested nose
  • Sore throat
  • Tightened check and neck muscles
  • Very rapid breathing
  • Difficulty talking
  • Fatigue and weakness
  • Chest tightness or pressure
  • Coughing and wheezing after exercise
  • Trouble sleeping

Listed below are some early and emergency signs that may indicate an impending severe asthma attack:

  • Shortness of breath
  • Breathing faster than normal
  • Chest tightness or pain
  • Low peak expiratory flow (PEF) readings
  • Increased use of quick-relief inhalers
  • Feelings of anxiety or panic

You need to seek medical attention right away if you experience the following warning signs:

  • Rapid heartbeat and pulse
  • Pale or blue lips and fingernails (cyanosis)
  • Nostril flare when breathing
  • Severe wheezing and chest pain
  • Symptoms fail to resolve even with quick-relief inhalers
  • Trouble with talking or walking due to shortness of breath
  • Confusion 
  • Loss of consciousness

How is asthma diagnosed and treated?

 At the clinic, your doctor will begin the consultation by taking a detailed medical and family history, which will be followed by a physical examination. This process is done to rule out any other possible respiratory conditions. Your doctor will also discuss your symptoms and any other health concerns. In addition, they may also inquire about your history of allergies. If asthma is suspected, a number of lung function tests, such as spirometry, peak flow test, and a chest X-ray, may be carried out to confirm the diagnosis. Your doctor may also carry out some blood tests to assess your immune system, as asthma has the potential to increase the levels of white blood cells.

For more severe cases, a referral to a respiratory specialist may be necessary for further evaluation. Today, most asthma medications are inhaled, and preventers and long-term medication will be needed to prevent an asthma attack. Quick-relief inhalers, on the other hand, will play a key role in mitigating any exacerbations. Your treatment will also depend on the severity of your condition, and your medication may have to be adjusted as the severity changes over time. Although there is currently no cure for asthma, symptom management will allow you to live a normal and active life.

Should I Be Worried About Lung Nodules?

Lung nodules, also known as pulmonary nodules, are relatively common in clinical practice and are often discovered incidentally. In fact, about 30% of  patients who undergo a CT scan have at least one lung nodule. While the majority of these patients are those who smoke or were previously smokers, individuals who do not indulge in this habit can also develop pulmonary nodules. The question then is whether the lung nodule is cancerous.

What are lung nodules?

Lung nodules are abnormal growths that develop in the lung, typically surrounded by normal lung tissue. These nodules appear as round, white shadows and are often known as coin lesions due to their coin-like appearance. Most lung nodules are small and less than 10 mm, but some may be larger and can even be seen on a chest X-ray. They may occur as a result of a past lung infection or inflammation due to the presence of scar tissue.

When the lung becomes inflamed, a small clump of cells may develop, hardening over time causing a nodule. Apart from infections, other causes may also play a role in the development of this condition. These may range from autoimmune disorders, sarcoidosis to other infections (bacterial, fungal and parasitic), benign tumours and even cancer. Moreover, certain congenital lung abnormalities may also cause lung nodules.

What are the signs and symptoms of lung nodules?

Most patients with lung nodules do not present with any symptoms and are often too small to cause any respiratory issues. This is why most nodules are commonly detected incidentally during an X-ray or CT imaging when they come into the clinic for a different concern. However, many experts believe that with the rise in the usage of CT scans plus the advances in CT scan technology, the incidence of this condition has taken a steep incline. If a patient does experience any symptoms, they are most likely caused by an underlying condition that resulted in the formation of the lung nodule rather than the condition itself.

If symptoms do occur, they may cause the following:

  • Fever
  • Wheezing
  • Dyspnea (shortness of breath)
  • Hoarse voice
  • Coughing up blood
  • Persistent cough
  • Fatigue
  • Chest pain
  • Loss of appetite
  • Unintentional weight loss

It is important to note that, some patients may have trouble breathing and experience symptoms like coughing or wheezing, especially if the lung nodule is pressing against their airway.

Should I Be Worried About Lung Nodules?

Who are more likely to develop a lung nodule?

Those who smoke or have a history of smoking may be at risk of developing lung nodules. However, smoking is not the only risk factor. Here are some factors that may increase the incidence of lung nodules:

  • Age (older adults)
  • Exposure to dust eg: silica
  • Secondhand tobacco exposure
  • Past tuberculosis infections
  • Family history of lung disease
  • Family history of lung cancer

How do doctors detect lung nodules?

As mentioned earlier, most lung nodules are spotted incidentally on X-rays or CT scans. If the nodule is very small (<6 mm), the patient may not require a follow-up. However, in some cases, further evaluation might be needed, especially if the patient is in a high-risk group. They may also monitor the nodule (active surveillance) to determine its size and shape and to see if it grows over time, as this will provide clues in gauging if the nodule is cancerous or not. If the nodule is deemed to be suspicious, a biopsy will most likely be recommended. This involves the removal of a small tissue sample, which will be sent for further analysis by a pathologist.

Can lung nodules be cancerous?

In most cases, lung nodules are benign (not cancerous) and do not even need any treatment. Less than 5% of cases turn out to be cancerous, and a biopsy is necessary to confirm the malignancy. While lung cancer has a poor prognosis in its advanced stages, the outcome can be favourable if detected early. Therefore, if you are at high risk for developing lung cancer, it is advisable to undergo lung cancer screening.

High-risk groups

Individuals with more than a 20-pack-year history of smoking and are between the ages of 50 and 80.
Individuals who currently smoke or have quit within the past 15 years.

Those in the high-risk groups are recommended to undergo annual screening for lung cancer, which involves a low-dose CT scan of the chest (LDCT). It is similar to a normal CT scan but with a lower dose of radiation. This test usually takes only around five minutes and will provide a detailed image of your lungs.

When determining the likelihood of lung cancer, a few important characteristics will be taken into account: the size, shape, presence of calcification, and number of nodules. Larger and more irregular lung nodules are considered more worrisome while those that contain calcium are usually non-cancerous.

Furthermore, the location of the nodule will also be taken into consideration, with many studies indicating that nodules located in the upper lobe of the lung are more likely to be cancerous.

How are lung nodules and lung masses managed?

For those who have a lung infection, antibiotics may be provided to treat the condition. If the lung nodules are cancerous, doctors should have them surgically removed. The most commonly performed surgical procedure for malignant lung nodules is VATS (video-assisted thoracic surgery). The outlook of lung nodules will depend on whether they are cancerous or not and the stage of the disease.

If a patient has a growth larger than 4 cm, it is referred to as a lung mass and the risk of malignancy increases. Malignant masses often occur due to lung cancer, and management may involve both medical and surgical treatment options, including chemotherapy, radiation therapy, immunotherapy and lung resection. Patients may also be advised to follow a number of lifestyle changes, such as quitting smoking. Regular check-ups with your pulmonologist will also be advisable.

When do I need to see a pulmonologist, and what to expect?

The respiratory system includes the lungs, trachea, bronchi, pharynx and other organs, and they help facilitate breathing. Suppose you have been diagnosed with lung disease or have trouble breathing, like shortness of breath (dyspnoea); your general practitioner may refer you to a pulmonologist. But what is the role of a pulmonologist? A pulmonologist is a specialist who diagnoses and treats respiratory conditions. These specialists are equipped with the experience and expertise required to address any respiratory illness that you may have. If you have not consulted a pulmonologist before, we will walk you through what can be expected at the clinic and how you can prepare for your visit.

What conditions do pulmonologists treat?

Pulmonologists are trained to diagnose and manage various lung diseases. Some conditions treated or managed by pulmonologists include, but aren’t limited to:

  • Aspergillosis: This is a fungal infection caused by common mould (aspergillus) and causes breathing difficulties.
  • Asthma: Bronchial asthma is a long-term condition that causes breathing difficulties due to the narrowing of the airways.
  • Bronchiectasis: This condition occurs when the airways become widened, thickened, and permanently damaged, making the lungs vulnerable to infection.
  • Bronchitis: In bronchitis, the airways (bronchial tubes) leading to the lungs are inflamed and filled with mucus resulting in a nagging cough.
  • Chronic Obstructive Pulmonary Disease (COPD): COPD is a chronic inflammatory lung disease that causes airflow limitation and breathing difficulties.
  • Emphysema: This type of COPD develops over time and damages the lung tissue due to noxious elements like cigarette smoke.
  • Interstitial lung disease: Interstitial lung disease or diffuse parenchymal lung disease (DPLD) comprises a large group of diseases (over 200 conditions) that causes inflammation and scarring in the lungs.
  • Lung cancer: Lung cancer or carcinoma refers to cancer that forms in the tissues of the lungs; this may spread to lymph nodes and other organs and may even lead to severe consequences and death
  • Pneumonia: Pneumonia can be a viral, bacterial, or fungal infection that causes inflammation in one or both lungs. Symptoms include cough with phlegm or pus, fever, and difficulty in breathing.
  • Pulmonary fibrosis: In this condition, the lungs become thickened and scarred, resulting in breathing difficulties.
  • Pulmonary hypertension: This is a severe condition with abnormally high pressure in the blood vessels that supply blood to the lungs resulting in fatigue and shortness of breath.
  • Sarcoidosis: This rare condition is characterised by clusters of inflammatory cells known as ‘granulomas’; the cause is unknown, but most evidence suggests that it occurs due to an aberrant immune response.
  • Sleep apnea: If you snore loudly and still feel exhausted after a good night’s sleep, you may have sleep apnea; this potentially serious sleep disorder is characterised by frequent breathing ‘stops’ and ‘starts’.
  • Tuberculosis (TB): TB is a potentially serious bacterial infection that mainly affects the lungs but can also affect other parts of the body.

What symptoms and signs indicate you need to consult a pulmonologist?

There are a number of symptoms and signs that may suggest a visit to the clinic. Let’s take a look at a few symptoms:

  • Shortness of breath: If you have been experiencing breathing difficulties during physical activity or rest, this could indicate an underlying respiratory condition.
  • Fatigue: Feeling tired after an activity is normal, but if you feel worn out all the time, this could be a sign of a lung condition such as COPD.
  • Chronic cough: A severe cough or a lingering cough that has lasted for more than three weeks needs to be investigated.
  • Wheezing: This is a high-pitched whistling sound that may occur while breathing; this may be a symptom of conditions such as asthma, pneumonia, bronchitis, and more.
  • Recurrent colds or respiratory infections: Frequent infections need to be further investigated by a pulmonologist.
  • Abnormal imaging investigation findings: If you have any abnormalities on your chest X-ray or CT scan, you may need to get it evaluated by a pulmonologist.
What to expect at the clinic and how to be prepared?

At first, the specialist will take a detailed medical and family history, followed by a physical examination. This is performed to determine the diagnosis and to commence the required management. Depending on your symptoms and medical history, they may also require a few investigations, such as a chest X-ray, spirometry, bronchoscopy, or a CT scan, to make the proper diagnosis.

Being prepared before your appointment will help you make the most out of your visit. Make sure that you bring any relevant past medical records and make a note of your past and current medications, including any over-the-counter (OTC) supplements or vitamins.

It is advisable to wear loose-fitting and comfortable clothing, as you may be required to undergo tests that require deep breathing or physical activity. If you have any questions or concerns, don’t forget to write them down so that you can get them clarified at the clinic. Lastly, it is recommended that you bring a family member to accompany you at the appointment. This will help you be at ease and free from anxiety or stress.

Smoking and lung cancer

Smoking is one of the most harmful habits a person can get into. It is a major contributor of several chronic illnesses and lung cancer, so it would be wise to think twice before lighting that cigarette. For many smokers, it is not too late for a lifestyle change and there are now proven ways that can help smokers kick the habit. 

What is lung cancer?

Lung cancer is a type of cancer that begins in the lungs and may spread to other parts of the body, including the lymph nodes, liver, bones, and brain. The lungs may also get affected by cancer cells from other organs; this is referred to as metastasis.

The leading cause of lung cancer worldwide is cigarette smoking. This also includes the smoking of pipes as pipe tobacco contains many of the same type of carcinogens as cigarette tobacco. 

Cancer risk increases with the time and number of cigarettes smoked. However, if a person quits smoking (even after smoking for many years), the chances of reducing the risk of developing lung cancer can be significant. Smoking cessation medications and counselling can be effective in helping you stay away from smoking in the long term. 

Active smoking is not the only way an individual may get lung cancer. Inhaling secondhand smoke, also known as involuntary or passive smoking, can pose a considerable risk. Therefore, stopping smoking will not only reduce the risk of lung cancer and improve the health of the smoker but that of household members as well.

Other risk factors associated with lung cancer include:

  • Family history of lung cancer.
  • Occupational exposure to substances such as asbestos, arsenic, chromium, beryllium, nickel, or tar.
  • Exposure to radiation from radiation therapy, radon, or imaging investigations, such as CT scans.
  • Air pollution

lung_cancer

Types of lung cancers in smokers

Smoking has the potential to cause two particular types of lung cancer. They are:

  • Small cell lung cancer (SCLC): This type of cancer is uncommon and is usually found in individuals with a long history of tobacco smoking; Early diagnosis and management  has the potential to increase life expectancy.
  • Non-small cell lung cancer (NSCLC): This epithelial lung cancer accounts for more than 80% of lung cancers and can be classified into three subtypes – squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. Squamous cell cancer is typically associated with long-term smoking.
What are the symptoms and signs of lung cancer?

The following symptoms and signs may be seen with lung cancer:

  • Headache
  • Chronic cough
  • Chest pain
  • Breathing difficulties
  • Hoarse voice
  • Blood in sputum (phlegm or mucus)
  • Loss of appetite
  • Unintended weight loss
  • Fatigue
  • Bone pain
  • Swelling of the face and neck veins

In the early stages of lung cancer, patients may be asymptomatic (no symptoms). Symptoms usually occur when the disease is advanced. As such, if you believe you are at risk or have symptoms that do not resolve on their own, it is advisable to see a lung specialist who will be able to conduct a thorough evaluation of your respiratory condition and advise on appropriate treatment if necessary.

How does smoking cause lung cancer?

The lung isn’t the only place affected by cigarette smoking. It can affect other parts of the body, such as the mouth, voice box, trachea, oesophagus, stomach, colon, rectum, liver, pancreas, and so on. It also significantly impacts an individual’s DNA or deoxyribonucleic acid (the hereditary component in humans). It can increase DNA methylation — a biological process that can change the activity of DNA segments and cause DNA damage. Smoking provides direct exposure of the epithelial tissue to at least 60-70 harmful carcinogens that may result in the damage of segments of DNA and thereby leading to lung cancer.

Some examples of such toxic carcinogens include:

  • Arsenic
  • Benzene
  • Cadmium
  • Formaldehyde
  • Nickel
  • Lead
  • Isoprene
How to diagnose and treat lung cancer?

The following investigations may be carried out to diagnose lung cancer:

  • Medical and family history.
  • Physical examination.
  • Imaging tests, such as chest X-ray or CT scan.
  • Lab investigations (including blood and sputum tests).
  • Lung biopsy.

Once the diagnosis is made, the specialist will classify the cancer according to the stages — this will offer integral information regarding the extent of cancer and the required response to the treatment. Screening for lung cancer is generally performed using a low-dose computerised tomography scan (LDCT). This scan doesn’t take up much time and isn’t painful.

How to prevent lung cancer?

Here are some strategies which can help prevent lung cancer:

  • Stop smoking.
  • Avoid secondhand smoke.
  • Reduce exposure to toxic chemicals such as asbestos, arsenic, radon, and lead.
Electronic cigarettes

While electronic cigarettes (e-cigarettes) appear less harmful than cigarettes, they are not safe. E-cigarettes (also known as vaping products) contain many harmful chemicals such as nicotine and heavy metals that can be inhaled deep into the lungs. The flavours in e-cigarettes are also known to be carcinogenic. Vaping comes with the risk of serious lung diseases like asthma, lung scarring, popcorn lung among others. It is generally believed that e-cigarettes don’t usually contain tobacco but this is not always the case; E-cigarettes often contain nicotine which comes from tobacco and is the key ingredient responsible for continued addiction. As such, e-cigarettes are classified as tobacco products by the Food & Drug Administration (FDA) in the U.S.

There are several harmful health effects linked with prolonged tobacco use. They include:

  • Heart disease
  • Stroke
  • Leukaemia
  • Type 2 Diabetes
  • Cataracts

Cigarette smoking is one of the major causes of illness and death in Singapore. According to statistics, over 90% of lung cancer cases are caused by smoking. Therefore, it is wise to consult a lung specialist if you need any assistance with quitting smoking.

Can you die from pneumonia?

Pneumonia is a common infection that can be contracted by anyone at any stage or age. In most cases, the patient recovers completely. Occasionally, especially in older patients, the condition stays undiagnosed and untreated until it becomes life-threatening. It is one of the leading causes of death in both children and adults and is among the top five causes of death in developed countries. 

Pneumonia

pneumonia

Pneumonia is an infection that occurs when the alveoli (air sacs) of the lungs get inflamed. This inflammation is usually caused by a bacterial or viral infection. However, other organisms, such as fungi and parasites, may also cause pneumonia in some patients who have weak immunity. Some types of pneumonia can be contagious. Many viruses and bacteria that cause pneumonia are easily transmitted from one person to another, but some types aren’t usually infectious, such as fungal and aspiration pneumonia.

Pneumonia can vary in severity depending on the age and immunity of the individual. The most vulnerable patients are infants, young children, older patients (over the age of 65), and individuals who are immunocompromised (such as patients with AIDS, or those with cancer undergoing chemotherapy). Individuals who smoke are also at risk of being infected with pneumonia. But this does not mean that healthy individuals will not get infected as anyone can be at risk of pneumonia. Early medical treatment can, however, help in curing the infection and preventing possible complications.

What are the symptoms of pneumonia?

Although this condition may present itself like the common cold or flu, there are some common symptoms that are suggestive of pneumonia:

  • Fever with chills and sweating
  • A feeling of general malaise and fatigue
  • Cough with mucus (green, yellow, or with blood)
  • Headaches
  • Loss of appetite
  • Difficulty breathing
  • Chest pain
  • Joint aches
  • Confusion
  • Bluish lips and fingernails

If the symptoms mentioned above are noticed, or the condition starts worsening, your general practitioner may refer you to a lung specialist.

How is pneumonia classified?

This condition can be classified according to the type of pneumonia, how it is acquired, and the degree of severity.

Types of pneumonia:

  • Viral
  • Bacterial
  • Mycoplasma pneumonia (walking pneumonia)
  • Fungal pneumonia

How it is contracted:

  • Community-acquired pneumonia
  • Hospital-acquired pneumonia
  • Ventilator-acquired pneumonia

Degree of severity:

  • Mild
  • Moderate
  • Severe
How does pneumonia lead to death?

When an individual gets infected with pneumonia, the alveoli begin to fill with fluid or pus, which may result in fever, chills, and difficulty breathing and ultimately lead to asphyxiation. Without prompt treatment, there is a risk of severe consequences and even death. Pneumonia can also result in a number of complications, such as:

  • ARDS (acute respiratory distress syndrome): This type of lung injury causes respiratory failure due to the fluid build-up in the lungs.
  • Pleurisy: This condition occurs when the pleura (lining of the lungs) becomes inflamed and causes sharp chest pains.
  • Lung abscess: This lung infection is characterised by a cavity filled with pus; it is usually caused by bacteria in the oral cavity.
  • Respiratory failure: This condition occurs when the respiratory system fails to adequately carry out the gas exchange leading to low oxygen or excess carbon dioxide in the blood.
  • Sepsis: In this condition, the immune system overreacts to an infection and can lead to organ failure and death.
How is pneumonia diagnosed and treated?

Before making a diagnosis, the lung specialist will take a complete medical history and conduct a thorough physical examination. Further testing may also be required for diagnosis. Investigations may include:

  • Blood tests
  • Chest X-ray
  • Sputum culture
  • Pulse oximetry
  • Chest CT scan
  • Pleural fluid culture
  • Bronchoscopy

In some cases, the patients may be treated at home while for severe cases, patients may need to be treated hospitalised. Mild pneumonia can be treated with antibiotics (if the pathogen is bacterial), accompanied by plenty of rest and a high fluid intake. Cough suppressants, pain relievers, and oxygen therapy may be required, especially if the condition is severe. Most cases of viral pneumonia do not require any treatment and may resolve on their own. 

Immunisation can help with the prevention of pneumonia. As the flu is one of the most common causes of pneumonia, a yearly flu vaccine is highly recommended. In addition, a pneumococcal vaccine can protect patients from bacterial pneumonia. It is recommended that infants, those older than 65 years, and those with a weak immune system be vaccinated.

In addition to these vaccinations, there are other ways in which this disease can be prevented:

  • Cover your mouth and nose when you cough or sneeze.
  • Wash your hands regularly.
  • Practise good hygiene
  • Stop smoking.
  • Avoid excessive alcohol consumption.
  • Avoid crowded places
  • Follow a healthy lifestyle that includes adequate rest, exercise, as well as a healthy and balanced diet
  • Keep a distance from those who may be suffering from infectious diseases.
  • Ensure existing chronic conditions are well-controlled, such as asthma, chronic cough, COPD, heart disease, and diabetes.

Getting infected with pneumonia can be serious. It is therefore important that you be aware of your general health and not wait to seek medical help when you feel unwell, especially when you have a respiratory infection.