Pneumonitis is a lung disease that is often detected very late. The triggers of this disease are not caused by infection. Several causes of pneumonitis may interact and may also be the result of other diseases.
What is pneumonitis?
Pneumonitis is inflammation in the lung tissue. Pneumonitis is often confused with pneumonia, the classic lung infection. In pneumonitis, the triggers are not bacteria or fungi, but pneumotoxic influences. These are toxic effects on the lungs. Chronic inflammation of the lung tissue and scarring of the alveoli occur. Normal oxygen transport via the blood is no longer possible.
Causes
Causes that trigger pneumonitis include medications. Noxene is a substance that exerts a damaging and pathogenic effect on the human organism. In particular, drugs that are taken during chemotherapy and must be administered to the body fall into this category. Pneumonitis can also be triggered as a side effect during radiation therapy in the irradiated areas. Inhalation of chemical substances, gases and toxic smoke can also cause pneumonitis. Pneumonitis is also triggered by exogenous allergic alveolitis. It is an allergy-induced inflammation of the alveoli (structural elements in the lungs where gas exchange takes place). Substances such as fine dust are absorbed by inhalation. Pneumonitis can also occur in rare cases as a result of the disease toxoplasmosis.
Symptoms, complaints, and signs
The first symptoms that occur with pneumonitis are a dry, irritating cough and shortness of breath. In some cases, the body temperature also rises sharply and the affected person suffers from fever. A worsening of the general condition and a typical feeling of illness are observed in patients. After radiation treatment, these symptoms can appear four to twelve weeks, even several months after the therapy. With the modern techniques used, the incidence of pneumonitis has decreased significantly. The severity of the symptoms that occur depends on the compensation capacity of the lung volume irradiated with a low dose. The symptoms are aggravated by so-called superinfections. In particularly severe cases, ARDS, an acute respiratory distress syndrome, may occur. This is a massive inflammatory reaction of the human lung to various factors that cause damage to the tissue. As a result of the increase in pressure in the pulmonary circulation, cor pulmonale may also occur, which means that the heart is severely stressed by pressure. Respiratory distress syndrome and cor pulmonale can lead to death. Pneumonitis usually resolves on its own after several weeks. The result of pneumonitis may be irreversible fibrosis of the lung volume exposed to radiation. Permanent lung dysfunction may occur.
Diagnosis and course of the disease
To diagnose pneumonitis, a chest examination is performed. Milky opacities in the lung tissue are not evident on radiographs until four to eight weeks after therapy. To get a better picture of the lungs, an X-ray is followed by a computed tomography scan, which shows high-resolution images of the lungs. Pulmonary function tests also show the first signs of possible disease. The patient inhales air and must exhale it in a specific amount of time. This allows the doctor to measure how efficiently the lungs are working. An oximeter, which can evaluate how much oxygen is in the bloodstream, is often used to help. Here, a clip is attached to the finger. This method is completely painless for the patient. If a bronchoscopy is performed, it is a lung endoscopy. An endoscope is inserted through the trachea into the main bronchi. This also allows a tissue sample to be taken from the lungs.
Complications
Due to pneumonitis, the affected person suffers from various respiratory complaints. This usually involves shortness of breath and a severe cough. As a result, an undersupply of oxygen is also possible, so that the affected person appears fatigued and tired.The internal organs can also be irreversibly damaged by this undersupply. Fever and a general feeling of illness can occur as a result of the disease and have a very negative effect on the patient’s everyday life. Furthermore, strenuous activities or physical stress and sports are usually no longer possible for the affected person. As a rule, pneumonitis can be treated with the help of medication. Treatment with antibiotics is also necessary for pneumonitis. If the affected person suffers from severe breathing problems, therapy with oxygen is necessary. In some cases, pneumonitis can also lead to psychological discomfort or severe depression. It cannot be universally predicted whether there will be a complete cure when pneumonitis is treated. It is also possible that the patient’s life expectancy may be reduced.
When should you see a doctor?
Pneumonitis must always be treated by a physician. If the disease is not treated, in the worst case scenario, it can also lead to the death of the affected person or other complications. The doctor should be consulted for pneumonitis if the affected person suffers from respiratory problems over a longer period of time. In this case, the disease is manifested primarily by shortness of breath and by an irritating cough, even if the affected person does not exert himself. Frequently, fever can also indicate the disease. If these symptoms occur over a longer period of time and do not disappear on their own, a doctor must be consulted in any case. Likewise, decreased performance or persistent fatigue may indicate pneumonitis and should be investigated. Initial diagnosis and investigation of pneumonitis may be performed by a general practitioner or by an otolaryngologist. However, since further treatment depends on the exact causes of pneumonitis, another specialist is usually necessary. Early diagnosis and treatment have a positive effect on the course of the disease.
Treatment and therapy
In chemically induced pneumonitis, it is advised to suspend treatment with radiation therapy to largely rid the body of chemical components. This is thought to relieve symptoms and help improve the condition. In some cases of pneumonitis, other methods are used to bring about a cure for the inflammation. The administration of corticosteroids causes suppression of the immune system. This causes a reduction of inflammation in the lungs. Corticosteroids are taken in the form of tablets. Taking them over a long period of time can increase the risk of contracting an infection by reducing the performance of the immune system. The intake is also associated with the onset of the bone disease osteoporosis. Oxygen therapy is additionally necessary if the patient suffers from severe breathing problems. If water collects in the lungs, breathing is severely restricted. Oxygen must be taken into the organism via an oxygen mask or as a result of intubation. Many sufferers require permanent oxygen therapy. In order to keep the airways open, additional stents are used to keep the walls between the trachea and the bronchi apart, especially in the case of narrowing caused by tumors.
Prevention
Regular checkups are necessary to quickly detect a change in lung tissue during radiation therapy. In individual cases, advanced diagnostics are arranged to assess the severity. Thus, an early dose reduction or a change of therapy can limit the risk of pneumonitis and reduce late damage. However, if treatment is continued, there is always a risk of developing pneumonitis.
Follow-up
Because pneumonitis is detected relatively late in most cases, there are usually few and also limited measures of follow-up care available to those affected by this disease. Affected individuals are therefore in any case dependent on a diagnosis as early as possible in order to alleviate the symptoms of the disease and also to avoid other complications. There is no independent cure, so a visit to a doctor is always necessary for this disease. The earlier the doctor is contacted, the better the further course of the disease often is. The treatment itself is usually carried out with the help of various medications. Those affected should always take the medication regularly and follow the prescribed dosage.Similarly, those affected by pneumonitis should not engage in unnecessary exertion or stressful activities. Therefore, many patients are dependent on the help of other people in their daily lives. Loving conversations have a positive effect on the further course of the disease and can limit or prevent psychological complaints in particular. In general, however, pneumonitis reduces the life expectancy of the affected person in many cases.
What you can do yourself
Sufferers of pneumonitis should minimize their consumption of airborne pollutants. In particular, environments where there is inhalation of nicotine, dyes, or other toxins should be avoided. Smoking is to be refrained from as a matter of principle in the context of self-help. Rooms should be ventilated regularly and stays in nature strengthen the organism. Since a chronic course of the disease is possible in the further process, the body’s own defense system needs sufficient support at an early stage. A balanced diet and a healthy lifestyle are essential for this. Excess weight is to be avoided and possible stressors are to be reduced. Sleep rhythms should be observed and sleep hygiene should be optimized. Inner strength can be built up through various relaxation techniques. Special breathing techniques also help to alleviate the existing complaints. Often in pneumonitis there is shortness of breath. The affected person should learn not to panic. Severe anxiety or panic phases increase the discomfort and thus worsen the overall situation. It is important for coping with the disease to remain calm at all times and to develop different strategies at an early stage that offer a way out in critical situations. Physical stress should be avoided. As soon as it comes to performing a strenuous activity, regular breaks and timely rest periods should be observed.
