Wheezing when lying down: Causes, treatments, and more - Medical News Today
Wheezing when lying down: Causes, treatments, and more - Medical News Today |
- Wheezing when lying down: Causes, treatments, and more - Medical News Today
- COVID's lingering effects can put the brakes on elective surgeries - FierceBiotech
- Respiratory Infection RSV Surges in South as Mask Use, Distancing Decline - Medscape
| Wheezing when lying down: Causes, treatments, and more - Medical News Today Posted: 23 Jun 2021 06:00 AM PDT  Wheezing is a sensation that occurs when a person breathes through obstructed airways. Some people find that their wheezing gets worse when lying down. This can occur because lying down may adversely affect the ability of the chest to rise and fall, making it difficult to breathe. Lying down may also cause problems with mucus drainage from the nose, which could trigger a cough. Wheezing is a common symptom of asthma, allergies, chronic obstructive pulmonary disease, and obstructive sleep apnea. In this article, we will take a closer look at the potential causes of wheezing when lying down and their treatments. We will also provide tips on how to sleep while experiencing this symptom. Asthma is a chronic condition that affects over 300 million people worldwide. It is characterized by coughing, wheezing, or shortness of breath. It is common for asthma symptoms to affect people at night. This is known as nocturnal asthma. The symptoms of nocturnal asthma can include:
According to the United Kingdom charity, Asthma UK, nocturnal asthma can be a sign that a person's asthma is not well-controlled. People with asthma symptoms at night may be at risk for asthma attacks. Doctors can prescribe preventive inhalers to improve breathing. People can use these regularly to maintain reduced asthma symptoms. Emergency inhalers can help with sudden and sometimes severe symptoms. Those with allergies may find that identifying and removing the allergen helps, along with taking an antihistamine. OSA is a serious medical condition that causes a decrease or abrupt halt in airflow while sleeping. This occurs due to the relaxation of the pharyngeal muscles and soft tissues, which are located at the back of the throat. This blocks the airways, disrupting breathing. The symptoms of sleep apnea include:
Treatment for OSA may include wearing a device over the mouth at night to help keep the airways open. Continuous positive airway pressure (CPAP) machines are often the best option, but in complex cases where a CPAP machine is not suitable, surgery may be necessary. Anxiety disorders are a common mental health condition. A 2015 study from Germany found that they affect up to 33.7% of the population. In addition to causing emotional changes, anxiety can cause physical symptoms. Examples include:
If a person feels anxious at night, they may find that the feeling of additional pressure of gravity on the chest leads to bronchospasm (narrowing of the airways) that can cause a wheezing noise. Anxiety and stress can also make it more likely a person will react to allergens, which can trigger asthma. Treatment typically involves talking therapy, but can also include medications to manage symptoms. Another potential cause for wheezing is obesity. A randomized study of just over 86,000 adults found that a higher body mass index (BMI) was associated with wheezing, while a 2019 study found that a higher BMI was associated with fat deposits in the lungs. This may explain why individuals with obesity can experience wheezing, as well as other breathing difficulties. People can reach a moderate weight by making dietary changes, doing regular exercise, and treating any underlying conditions that may be contributing to excess weight. Bronchitis refers to the inflammation of the bronchi, which are the large air passages inside the lungs. In 95% of all cases, acute bronchitis occurs because of a viral infection, such as a cold. Bronchitis can also occur due to bacteria, allergens, or pollutants, such as smoke. The symptoms of acute bronchitis include:
Acute bronchitis that is caused by a virus will often get better on its own. The cough may last 10–20 days. Treatments for bronchitis will vary depending on the cause. For viral infections, doctors typically recommend rest and treatments that can reduce a cough. This could include throat lozenges, hot tea, or over-the-counter (OTC) cough medications. Learn more about home remedies for bronchitis, and when to see a doctor. GERD occurs when stomach contents, including stomach acid, flow back up into the esophagus. The symptoms of GERD include:
There is a greater risk for GERD to occur in people with asthma. This is because asthma episodes can cause the lower part of the esophagus to relax, allowing stomach acid into the esophagus. Stomach acid can also cause asthma or COPD symptoms, such as wheezing, by entering and irritating the airways. Lifestyle changes, such as avoiding foods that contribute to flare-ups, can reduce GERD symptoms. Doctors can also prescribe medications to reduce stomach acid production. COPD is a condition that progressively makes it more difficult to breathe. The main cause is tobacco smoking, although around 25% of cases are not linked to smoking. The symptoms of COPD include:
Some people with COPD have different symptoms to these. Some can also have mild symptoms that they do not notice to begin with. There is no cure for COPD, but there are things doctors can do to relieve symptoms and slow the progression of the disease. These include prescribing medications to help open the airways, pulmonary rehabilitation, supplemental oxygen therapy, and surgery. Heart failure prevents the heart from pumping enough blood to support organ health and normal breathing. It is a serious condition that can be fatal. The potential symptoms of heart failure include:
Many of these symptoms may not be noticeable until the condition has become advanced. People can reduce the symptoms of heart failure through medications, such as diuretics, beta-blockers, ACE-inhibitors, and aldosterone antagonists. Some drugs, as well as devices such as implantable cardioverter defibrillators, can prolong a person's life. People who experience wheezing when lying down may find it difficult to sleep. To improve quality of sleep, people can try:
It is important for people who regularly wheeze while lying down to seek medical attention. Doctors can help pinpoint the exact cause of the wheezing, and recommend treatments. If someone experiences any of the following symptoms, dial 911 or the local emergency department:
Wheezing while lying down is a common symptom of conditions such as asthma. It can also be the result of anxiety at night, GERD, or obesity. Some people may have a combination of several conditions. For example, those with GERD and asthma may find that acid reflux triggers their asthma symptoms when lying down. People who experience regular wheezing should seek medical advice. |
| COVID's lingering effects can put the brakes on elective surgeries - FierceBiotech Posted: 28 Jun 2021 06:45 AM PDT  The week before Brian Colvin was scheduled for shoulder surgery in November, he tested positive for COVID-19. What he thought at first was a head cold had morphed into shortness of breath and chest congestion coupled with profound fatigue and loss of balance. Now, seven months have passed and Colvin, 44, is still waiting to feel well enough for surgery. His surgeon is concerned about risking anesthesia with his ongoing respiratory problems, while Colvin worries he'll lose his balance and fall on his shoulder before it heals. "When I last spoke with the surgeon, he said to let him know when I'm ready," Colvin said. "But with all the symptoms, I've never felt ready for surgery." As the number of people who have had COVID grows, medical experts are trying to determine when it's safe for them to have elective surgery. In addition to concerns about respiratory complications from anesthesia, COVID may affect multiple organs and systems, and clinicians are still learning the implications for surgery. A recent study compared the mortality rate in the 30 days following surgery in patients who had a COVID infection and in those who did not. It found that waiting to undergo surgery for at least seven weeks after a COVID infection reduced the risk of death to that of people who hadn't been infected in the first place. Patients with lingering COVID symptoms should wait even longer, the study suggested. But, as Colvin's experience illustrates, such guideposts may be of limited use with a virus whose effect on individual patients is so unpredictable. "We know that COVID has lingering effects even in people who had relatively mild disease," said Don Goldmann, M.D., a professor at Harvard Medical School who is a senior fellow and chief scientific officer emeritus at the Institute for Healthcare Improvement. "We don't know why that is. But it's reasonable to assume, when we decide how long we should wait before performing elective surgery, that someone's respiratory or other systems may still be affected." The study, published in the journal Anaesthesia in March, examined the 30-day postoperative mortality rate of more than 140,000 patients in 116 countries who had elective or emergency surgery in October. Researchers found that patients who had surgery within two weeks of their COVID diagnosis had a 4.1% adjusted mortality rate at 30 days; the rate decreased to 3.9% in those diagnosed three to four weeks before surgery, and dropped again, to 3.6%, in those who had surgery five to six weeks after their diagnosis. Patients whose surgery occurred at least seven weeks after their COVID diagnosis had a mortality rate of 1.5% 30 days after surgery, the same as for patients who were never diagnosed with the virus. Even after seven weeks, however, patients who still had COVID symptoms were more than twice as likely to die after surgery than people whose symptoms had resolved or who never had symptoms. Some experts said seven weeks is too arbitrary a threshold for scheduling surgery for patients who have had COVID. In addition to patients' recovery status from the virus, the calculus will be different for an older patient with chronic conditions who needs major heart surgery, for example, than for a generally healthy person in their 20s who needs a straightforward hernia repair. "COVID is just one of the things to be taken into account," said Kenneth Sharp, M.D., a member of the Board of Regents of the American College of Surgeons and vice chair of the Department of Surgery at Vanderbilt University Medical Center. In December, the American Society of Anesthesiologists and the Anesthesia Patient Safety Foundation issued these guidelines for timing surgery for former COVID patients: • Four weeks if a patient was asymptomatic or had mild, non-respiratory symptoms. • Six weeks for a symptomatic patient who wasn't hospitalized. • Eight to 10 weeks for a symptomatic patient who has diabetes, is immunocompromised or was hospitalized. • Twelve weeks for a patient who spent time in an intensive care unit. Those guidelines are not definitive, according to the groups. The operation to be performed, patients' medical conditions and the risk of delaying surgery should all be factored in. "Long COVID" patients like Colvin who continue to have debilitating symptoms months after 12 weeks have passed require a more thorough evaluation before surgery, said Beverly Philip, M.D., president of the society. Now that COVID has been brought to heel in many areas and vaccines are widely available, hospital operating rooms are bustling again. "In talking to surgical colleagues, hospitals are really busy now," said Avital O'Glasser, M.D., medical director of the outpatient preoperative clinic at Oregon Health and Sciences University in Portland. "I've seen patients with delayed knee replacements, bariatric surgery, more advanced cancer." At the beginning of the pandemic, surgical volumes dropped dramatically as many hospitals canceled nonessential procedures and patients avoided facilities packed with COVID patients. From March to June 2020, the number of inpatient and outpatient surgeries at U.S. hospitals was 30% lower than in the same period the year before, according to McKinsey & Company's quarterly Health System Volumes Survey. By May 2021, surgical volumes had mostly rebounded, and were just 2% lower than their May 2019 totals, according to the May survey. Oregon Health and Sciences University clinicians developed a protocol a year ago for clearing any patient who had COVID for elective surgery. When obtaining patients' medical history and conducting physical exams, clinicians look for signs of COVID complications that aren't readily identifiable and determine whether patients have returned to their pre-COVID level of health. The pre-op exam also includes lab and other tests that evaluate cardiopulmonary function, coagulation status, inflammation markers and nutrition, all of which can be disrupted by COVID. If the assessment raises no red flags, patients can be cleared for surgery once they have waited the minimum seven weeks since their COVID diagnosis. Originally, the minimum wait for surgery was four weeks, but clinicians pushed it back to seven after the international study was published, O'Glasser said. "We are still learning about COVID, and uncertainty in medicine is one of the biggest challenges we face," said O'Glasser. "Right now, our team is erring on the side of caution." At Memorial Sloan Kettering Cancer Center in New York, doctors don't follow a specific protocol. "We're taking every patient one at a time. There are no hard-and-fast rules at this institution," said Jeffrey Drebin, M.D., Ph.D., chair of surgery. Clinicians work to find a balance between the urgency of the cancer surgery and the need to allow enough time to ensure COVID recovery, he said. For Brian Colvin, whose right rotator cuff is torn, delaying surgery is painful and may worsen the tear. But the rest of his life is on hold, too. A sales representative for an auto parts company, he hasn't been able to work since he got sick. His balance problems make him reluctant to stray far from his home in Crest Hill, Illinois, the Chicago suburb where he lives with his wife and 15-year-old son. Some days he has more energy and isn't as short of breath as others. Colvin hopes it's a sign he's slowly improving. But at this point, it's hard to be optimistic about the virus. "It's always something," he said. |
| Respiratory Infection RSV Surges in South as Mask Use, Distancing Decline - Medscape Posted: 28 Jun 2021 12:23 PM PDT  Doctors in Georgia and other Southern states have seen since April an unusual surge of a common respiratory virus that affects children and older adults. The spike in cases of respiratory syncytial virus (RSV) at this time of year is linked, at least in part, to children and others no longer widely wearing masks or social distancing to prevent COVID-19 infection, experts say. When masks began coming off, "we knew we'd see a really bad RSV season,'' said Dr Stephen Thacker, a pediatric infectious disease specialist in Savannah."Kids are getting infected at the same time.'' Thacker said the virus swept through his own household, starting with his youngest child. "I got it, too,'' he told GHN on Thursday. The CDC this month issued an advisory about the rise of RSV, which can lead to severe disease in young children and older adults. It's primarily spread via respiratory droplets when a person coughs or sneezes, and through direct contact with a contaminated surface. RSV is the most common cause of pneumonia and bronchiolitis (inflammation and congestion of the small airways in the lungs) in children under a year old in the United States. Each year in the US, the virus leads to an average of about 58,000 hospitalizations, with 100 to 500 deaths among children younger than 5 years old; and 177,000 hospitalizations with 14,000 deaths among adults aged 65 years or older. The virus is generally a leading cause of hospitalization for children in the nation. The risk is worse for children born prematurely and those with heart conditions or immune system problems, Thacker added. Fortunately, most people who get it, including infants, develop only mild symptoms like those of a common cold, such as congestion, runny nose, and coughing, the American Lung Association in Georgia said. Compared with previous years, RSV activity remained relatively low from May 2020 to March 2021, the CDC said. But since then, the infections have surged. Dr Flavia Rossi, a Tifton pediatrician, told GHN last week that her practice is seeing a substantial rise in RSV cases, and she linked the increase to masks no longer being worn as frequently. Health officials have seen an increase in RSV cases in Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, and Texas. More children and adults in the population may not have been exposed and infected while people were physically distancing and not mixing, said Dr Andi Shane, pediatric infectious disease physician at Children's Healthcare of Atlanta. Shane also noted that "some countries in the Southern Hemisphere, notably Australia and South Africa, also saw an interseasonal increase in children with RSV during their late spring and early summer of 2020-21, which like some parts of the Southeastern US may correspond with increased mixing of people as communities reopen and people travel." The Lung Association urges parents to watch for symptoms of RSV in their children, which include:
"Parents know their children best, and if they feel that their child is having problems breathing, refusing to drink, and is not acting as they usually do, they should be brought to medical attention," Shane said. "Children with underlying medical conditions are more likely to require hospitalization when they have an infection with RSV as well as other respiratory viruses such as influenza and SARS-CoV-2, the virus that causes COVID-19." Almost all children will have had an RSV infection by their second birthday, the CDC says. And most RSV infections go away on their own in a week or two. There is no specific treatment for RSV infection, though researchers are working to develop vaccines and antivirals (medicines that fight viruses). Due to reduced circulation of RSV during the winter months of 2020-2021, older infants and toddlers might now be at increased risk of severe RSV-associated illness. That's because these children have likely not had typical levels of exposure to RSV during the past 15 months, the CDC said. Thacker added that "the smaller you are, the smaller the nasal passages are, and a little mucus causes a lot of problems.'' A drug called Synagis can be used as a preventive measure against RSV in high-risk children, though insurers have at times balked at coverage of the medication, Thacker said. As a general preventive measure, he recommended practicing good hand hygiene, including frequent handwashing. Among recommended steps to relieve symptoms:
Symptoms in adults are typically consistent with upper respiratory tract infections, including a runny nose, a sore throat, coughing, headaches, fatigue, and fever. For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube. |
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