Hi CML Family. 

Thought this might be of interest given it's the winter months!

Sending my best to all of you!
Love,
Barbara Heathcote
Raleigh, NC

PS - It's from an e-newsletter I receive weekly entitled 'Bottomline 
Secrets'   
=========================

How to Avoid Pneumonia

William Schaffner, MD 
Vanderbilt University Medical Center

Special from Bottom Line/Health 


his time of year, we are usually bombarded with warnings about 
influenza -- and now there is concern about severe acute respiratory 
syndrome (SARS). But another respiratory disease -- one that often 
falls beneath the public radar -- poses a much greater threat. 

Fact: Each year, pneumonia strikes 4 million Americans. It is the 
seventh leading cause of death in the US, killing nearly 62,000 
Americans annually.* 

Problem: Early pneumonia symptoms are nearly identical to those of a 
cold or the flu, so many patients don't see their doctors until the 
condition is advanced and more difficult to treat. 

HOW PNEUMONIA DEVELOPS

Most cases of pneumonia occur when viruses, bacteria or fungi are 
inhaled into the lungs. Main types... 

Community-acquired pneumonia. People contract a viral infection in 
the course of daily life -- at work, at public gatherings, etc. A 
virus can be transmitted by inhaling airborne droplets from a sneeze 
or cough... or by touching our eyes or mouth after shaking hands or 
touching a contaminated hard-surface object, such as a telephone or 
doorknob. 

The viral infection lowers our resistance to bacteria, which can 
inflame the lungs and surrounding tissue, causing pneumonia.

Pneumonia can also develop when germ-laden foreign matter, usually 
from the sinuses or the throat, is inhaled (aspirated) into the 
lungs. At greatest risk: People with an impaired gag reflex, such as 
those who have suffered a stroke, brain injury or Parkinson's 
disease. 

Hospital-acquired pneumonia. The most serious form frequently occurs 
in patients in intensive-care units as well as in those who have had 
medical instruments, such as a ventilator tube, inserted into their 
respiratory tracts. Germs found in hospitals tend to be the most 
lethal. Beware: At least one-third of these germs are resistant to 
common antibiotics. 

People with weakened immune systems (due to AIDS, for example, or 
treatment with steroids or chemotherapy) also are vulnerable to 
pneumonia caused by opportunistic pathogens -- organisms that aren't 
dangerous for healthy people, but cause disease in individuals with 
compromised immunity. 

TELLTALE SYMPTOMS

Because so many people don't realize that they have pneumonia until 
it is advanced, treatment often is delayed until large portions of 
the lung or lungs are affected. 

Caution: Patients with any upper-respiratory infection are at risk 
for pneumonia because inflammation in the airways impedes their 
ability to expel secretions. These secretions provide a rich 
environment for the organisms that cause pneumonia. People with any 
chronic health problem that reduces mobility also are vulnerable to 
pneumonia because their ability to cough is impaired. 

Pneumonia symptoms to watch for... 

Coughing up green or yellow sputum. It often means that infection has 
entered the lung. 

Chills accompanied by a fever higher than 102�F. 

Chest pain that gets worse when you inhale.

Shortness of breath. 

See a doctor if you are getting sicker and experiencing an increase 
in the number of symptoms and/or the severity of them. Using a 
stethoscope, your doctor will listen for bubbling, crackling or 
rumbling sounds in your chest, all caused by infection and 
inflammation. A chest X ray will confirm a diagnosis of pneumonia. 

PREVENTION

Because pneumonia is the most common complication of the flu, 
everyone over age 50 should get a flu shot. Anyone with heart or lung 
disease, diabetes or compromised immunity also should get a yearly 
flu shot. The vaccine not only helps keep you healthy, but also 
prevents you from getting sick and spreading the illness to others. 

Also helpful: If you do get the flu, antiviral drugs, taken orally or 
by inhaler, shorten the duration of the illness and reduce your risk 
of infecting others. These drugs also reduce the chance that the flu 
will progress to pneumonia. Zanamivir (Relenza) and oseltamivir 
(Tamiflu) must be taken within 48 hours of the onset of symptoms to 
shorten the duration of the flu. 

Other prevention strategies... 

Get the pneumococcal vaccine (in addition to a flu shot) if you're 
age 65 or older or have risk factors for pneumonia. This vaccine will 
offer you further protection -- beyond the flu shot -- against the 
most common bacteria that cause pneumonia. Risk factors include 
cardiovascular disease, cancer, sickle cell anemia, diseases that 
weaken the immune system or a previous case of pneumonia. 

Don't eat or drink two hours before bed if you have chronic lung or 
gastric reflux disease. Lying down immediately after eating increases 
the risk that you'll aspirate stomach contents while you sleep. This 
increases the risk for pneumonia. Also helpful: Put two pillows under 
your torso to raise it an inch or two. Gravity will help keep stomach 
contents from entering the lungs. 

Wash your hands often throughout the day with soap and water, for at 
least 15 seconds each time, to curb your exposure to germs that cause 
pneumonia. Always wash your hands when you come in from outside and 
before you prepare and eat food. 

TREATMENTS

Treatments for pneumonia depend on the severity of symptoms and the 
organism involved. Bacterial pneumonias are usually treated with 
antibiotics. Severe cases of pneumonia may require therapy with 
oxygen and intravenous antibiotics. 

Some viral pneumonias can be treated with drugs, such as amantadine 
(Symmetrel), zanamivir or oseltamivir, but the main approach is the 
same as that for the flu -- plenty of fluids, rest, etc. 

Also important... 

Positive-pressure breathing exercises. Your doctor may ask you to 
blow as hard as you can every hour or two into an incentive 
spirometer, a device consisting of a tube attached to a handheld 
plastic chamber. Blowing into this mechanism increases pressure in 
the bronchial tubes and promotes lung drainage. This helps eliminate 
infectious material and makes breathing easier. 

Stay upright as much as possible during recovery. An upright position 
makes it easier for the chest muscles to move and bring in oxygen. It 
also makes it easier to cough and expel potentially harmful 
secretions. 

*The top six leading causes of death in the US are 1. heart disease 
2. cancer 3. stroke 4. chronic lower respiratory disease 5. accidents 
6. diabetes.







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