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Causes of Shortness of Breath During Pregnancy

According to a 2015 study, an estimated 60 to 70 percent of women experience shortness of breath during pregnancy.

Doctors often attribute this to the growing uterus pushing upward on the lungs and making it difficult to breathe.

This article will explore this and other possible reasons for shortness of breath during pregnancy. We also cover coping strategies and when to see a doctor.

Causes

Shortness of breath is a common symptom during pregnancy.

While shortness of breath is a common symptom of pregnancy, it is not always possible for a doctor to pinpoint one single cause.

Shortness of breath during pregnancy appears to be due to a variety of factors, ranging from the growing uterus to changes in the demands on the heart.

Some women may notice changes in their breathing almost immediately, while others see differences during the second and third trimesters.

First trimester

A fetus does not have to be very large to cause breathing changes in a pregnant woman.

The diaphragm, a muscular band of tissue that separates the heart and lungs from the belly, rises by as much as 4 centimeters during the first trimester of pregnancy.

The diaphragm's movement helps the lungs fill up with air. While some women may not be aware of changes in how deeply they can breathe in, others may notice they cannot take full, deep breaths.

As well as changes in the diaphragm, pregnant women often breathe faster due to increases in the hormone progesterone.

Progesterone plays an essential role in the fetus's development. It is also a respiratory stimulant, meaning it causes a person's breathing to quicken.

The amount of progesterone in a woman's body will increase throughout pregnancy.

While breathing faster does not necessarily cause shortness of breath, some women may notice changes in breathing patterns.

Second trimester

 

The heart working harder during pregnancy may cause shortness of breath.

Pregnant women may experience more noticeable shortness of breath in the second trimester.

The growing uterus commonly contributes to shortness of breath in the second trimester. However, some changes in the way the heart functions can also cause breathlessness.

The amount of blood in a woman's body increases significantly during pregnancy. The heart has to pump harder to move this blood through the body and to the placenta.

The increased workload on the heart can make a pregnant woman feel short of breath.

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A Chronic, Rare Lung Disease Causes More Than Just Irreversible Scarring of the Lungs

The American Lung Association offers resources and support for this serious, life-threatening lung disease

Pulmonary fibrosis is a rare lung disease that causes irreversible scarring of the lungs, which can cause shortness of breath and a persistent cough, and progressively gets worse over time. And because there is no cure, a diagnosis of pulmonary fibrosis can bring up a lot of emotions for both patients and caregivers. 

American Lung Association Better Breathers Clubs are in-person adult support groups that provide respiratory health information and resources. Close to 500 nationwide have primarily served individuals living with chronic obstructive pulmonary disease (COPD) – a lung disease that also gets worse over time and has no cure.  We've now taken steps, with support from Three Lakes Partners, to better equip this program to serve those living with pulmonary fibrosis and their caregivers that face similar issues as those facing COPD and other chronic lung diseases.  

Better Breathers Clubs meet regularly and are led by trained facilitators that provide group discussions on topics ranging from oxygen therapy and breathing techniques to home healthcare and lung transplants, as well as how to live a full and engaging life with a chronic lung disease.

"The most important part of a Better Breathers Club is not always the educational component but the relationships that form within the groups," said Deb Brown, Chief Mission Officer of the American Lung Association. "Being able to open up these Clubs to pulmonary fibrosis patients and caregivers is an obvious extension of the goal of these groups – which is to help individuals better connect to others in similar situations."

Pulmonary fibrosis is a challenging and unpredictable disease, and symptoms can progress quickly or stay stable for many years, but most succumb to the disease three to five years after diagnosis. There are ways to make living with pulmonary fibrosis easier, including oxygen therapy, pulmonary rehabilitation and medications to help slow disease progression. Additional factors include nutrition, exercise, and stress management, all of which have an impact on quality of life for those living with pulmonary fibrosis.

In order to accommodate new members with pulmonary fibrosis, American Lung Association health educators have been working with Club facilitators to expand educational components to include information specific to pulmonary fibrosis and learn how to...

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Lung Cancer Risk Drops Within 5 Years of Quitting Smoking

Smokers who quit have a substantially lower risk for lung cancer than current smokers even within 5 years of stopping smoking, new research shows.

"If you smoke, now is a great time to quit," says lead author Hilary Tindle, MD, MPH, the William Anderson Spickard Jr. professor of medicine, Vanderbilt University School of Medicine in Nashville, Tennessee.

"The fact that lung cancer risk drops relatively quickly after quitting smoking, compared to continuing smoking, gives new motivation," she said in a statement.

On the other hand, former heavy smokers still have over a threefold greater risk for lung cancer than those who never smoked for several decades after giving up the habit, the same research shows.

"Former heavy smokers need to realize that the risk of lung cancer remains elevated for decades after they smoke their last cigarette, underscoring the importance of lung cancer screening," said senior author Matthew Freiberg, MD, professor of medicine, Vanderbilt Center for Clinical Cardiovascular Outcomes Research and Trials Evaluation, Nashville, Tennessee.

The study was published online May 16 in the Journal of the National Cancer Institute.

Data from the Framingham Heart Study (FHS) Original as well as the FHS Offspring cohort were analyzed for lifetime smoking and lung cancer incidence from 1954 to 1958 for the Original cohort and between 1971 and 1975 for the Offspring cohort. Lung cancer rates were tracked through 2013.

Information on smoking habits was collected and participants were categorized as current, former, or never smokers. Some 3905 participants from the FHS Original cohort and 5002 participants from the FHS Offspring cohort were included in the analysis.

"Most people (89.5%) who were smoking at baseline quit during follow-up and never relapsed," the authors point out.

However, during a median follow-up of 25.1 years for the FHS Original cohort and 33.6 years for the FHS Offspring cohort, investigators documented 284 diagnoses of lung cancer.

"Among ever smokers, the majority of lung cancers (92.7%) occurred among heavy smokers, with 21.3 or more cumulative pack-years of smoking," researchers note.

In this subgroup of participants with 21.3 or more cumulative pack-years of smoking, the unadjusted lung cancer risk was greater than 10-fold higher compared with those who had never smoked.

Are you running a solid smoking cessation program in your practice? It’s time to with MD Spiro.

Table....

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Antibiotics in Infancy Linked to Childhood Atopic Asthma

An association between antibiotic treatment in the first week of life and atopic asthma in childhood found in a long-term study suggests an immune-mediated effect, possibly from early disturbance of gastrointestinal microbiota, according to researchers.

Emma Goksor, MD, PhD, University of Paediatrics, University of Gothenburg, Gothenburg, Sweden and colleagues explained that disturbed microbiota can affect the development of the immune system, thereby becoming a risk factor for asthma and allergies.

"Antibiotic treatment is known to affect the gastrointestinal microbiota and treatment of this kind during a vulnerable period of life could therefore have long-term effects," researchers wrote.

The researchers conducted a longitudinal cohort study of over 5,000 Swedish children born in 2003. Parents answered periodic questionnaires about their children from age 6 months through 12 years, with 76% of parents responding at 12 years. Additional information about the pregnancy and delivery were obtained from medical records.

The questionnaire at 6 months elicited information on admission to a neonatal ward during first week of life and treatment with antibiotics. At 12 months, it queried such factors as duration of breastfeeding, introduction of different foods, kinds of pets and dampness (defined by damage) at home. At 12 years, questions addressed the current health of the child, airway symptoms, food and environment allergies, and presence of eczema and/or rhinitis.

Asthma was categorized depending on age of onset and duration and persistence of symptoms. The researchers considered history of allergic rhinitis at 12 years in distinguishing between atopic and non-atopic asthma.

Current asthma was reported in 6.4% of the children at 12 years of age, with 65% having atopic asthma and 35% non-atopic asthma.  Current allergic rhinitis was reported in 52% of the children with current asthma and in 78% of those with atopic asthma. The cumulative prevalence of asthma to age 12 years was 14%, of which 30% had transient symptoms and 38% had late-onset symptoms. Relatively few (4%) reported persistent asthma.

Goksor and colleagues reported from multivariate analysis of risk and protective factors that treatment with antibiotics during the first week of life was an independent risk factor for atopic asthma, but not for non-atopic asthma at 12 years of age (adjusted odds ratio[aOR] 2.2; 95% Confidence Interval [CI]; 1.2-4.2) versus 1.4 (0.5-3.4). ...

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Large Study: No Link Between Vitamin D, Lung Cancer Risk

The "largest and most comprehensive observational study to date" provides no evidence of an association between serum vitamin D concentrations and risk for subsequent lung cancer and thus does not support the idea that vitamin D is protective.

In a study by an international research group, pooled analysis of circulating vitamin D concentrations in prediagnostic blood from 5000 case-control pairs showed there was no dose-response relationship between select concentrations of vitamin D and lung cancer risk overall (odds ratio [OR], 0.98).

There was also no evidence of an association between vitamin D and lung cancer risk with respect to sex, age, smoking status, or histology, say Paul Brennan, MD, of the International Agency for Research on Cancer (IARC), in Lyon, France, and colleagues.

The analysis, embedded within the larger Lung Cancer Cohort Consortium (LC3) project, which involves more than two million participants from 20 cohorts in Asia, Australia, Europe and North America, was published online on April 2 in the Annals of Oncology.

"We interpret this to mean that vitamin D supplementation is unlikely to prove broadly effective for the primary prevention of lung cancer, regardless of whether or not you smoke," Brennan told Medscape Medical News. "The most important way to protect oneself against lung cancer is to stop smoking or never begin smoking," he added.

Unlike previous studies that relied on participants' self-reported tobacco use, this analysis identified recent tobacco exposure using measures of serum cotinine, a nicotine metabolite found in blood, the study authors note.

"Our results are important because many prevention strategies are still focused on vitamin D supplementation as a protective measure against a number of diseases, including cancer," said Brennan in a statement issued by the IARC.

Lung cancer remains the number one cause of cancer death globally. It accounts for nearly 1.7 million deaths annually and 20% of all cancer deaths overall. Although the primary cause of lung cancer is tobacco exposure, the lifetime risk for lung cancer among former smokers remains high, and never-smokers are also at risk.

"Given the high incidence of lung cancer worldwide, it is vital to prioritize efforts to reduce tobacco smoking and to identify additional preventive measures that may help to reduce the risk of the disease," said Christopher Wild, PhD, director of IARC, in the statement. "However, despite previous...

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Did Barbara Bush Suffer from COPD? A Doctor Explains.

Former First Lady Barbara Bush died on April 17, 2018, two days after spokespeople said that she had decided not to seek additional medical treatment. CNN had reported that Barbara Bush had COPD.

Beginning of interview:

I am a respiratory disease physician and professor at the University of Pittsburgh School of Medicine, and I direct the COPD clinical and research programs. My research has been inspired by real clinical problems when facing my lung disease patients whom I have worked with over the past 30 years.

COPD is a chronic respiratory condition that results in cough and shortness of breath. It often gets worse. It affects up to 16 million people and is the third-leading cause of death in the United States behind heart disease and stroke. It further results in 6 percent of all deaths worldwide.

The disease is most commonly caused by tobacco smoking and is thus often preventable. Mrs. Bush smoked cigarettes for decades, she wrote in her biography, but quit in 1968. One-fourth of cases occur in nonsmokers, in part due to other environmental exposures. COPD is often undiagnosed because of its slow onset. Also, people often assume that their coughing is “smokers’ cough,” or old age. Women are more likely than men to be diagnosed with COPD.

COPD includes several different conditions, including emphysema and chronic bronchitis. They can occur separately or together.

Normal lungs have bronchial tubes that branch like a tree into smaller and smaller tubes, which end in tiny elastic air sacs called alveoli. These fill up as we breathe in and snap back empty when we exhale.

In COPD, the airway tubes narrow due to inflammation, increased mucous production and, eventually, scarring, which is known as chronic bronchitis. Further, the walls of the alveoli can break down, as do small bubbles coalesce to form larger bubbles. This is known as emphysema. As a result, they do not snap back as easily when a person exhales. They have less ability to transfer oxygen into, and remove carbon dioxide from, the blood.

These different processes result in a prolonged and incomplete exhalation, and air remains trapped in the lungs when the next breath begins. As the condition progresses, it becomes increasingly hard to breathe. This results in more fatigue, a decreasing ability to exercise, declining activity and a lower quality of life.

Many COPD patients develop recurrent chest colds, often requiring hospitalization and rising medical...

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Exposure to traffic air pollution increases risk of asthma

Researchers from the French Institute of Health and Medical Research are reporting that outdoor air pollution is causing more widespread asthma symptoms.

According to the study, long-term exposure to traffic and ozone significantly increases the risk of asthma attacks, and also increases the need for asthma medication and treatment.

“It is very well known that short-term exposure to air pollution is associated with increased asthma symptoms, hospitalizations and use of asthma medication, but studies on the associations between long-term exposure to outdoor air pollution and asthma among adults are still scarce,” explained lead author Anaïs Havet.

“We wanted to try and better understand the underlying biological mechanisms associated with outdoor air pollution and increased asthma symptoms, asthma attacks or medication use, as up to now they were largely unknown.”

For their investigation, the experts obtained cohort study information on 608 French adults, including 240 individuals who had asthma with respiratory symptoms, asthma attacks, or increased medication use in the previous 12 months. The research team used this data to estimate the impact of long-term exposure to heavy traffic, particulate matter, and ozone.

The researchers also examined the link between asthma, exhaled 8-iso, and outdoor air pollution. A high concentration of 8-iso can cause contraction of the airway muscles, which makes it hard to breathe.

The study revealed that 8-iso concentration, high traffic intensity, and ozone exposure increased the risk factors in individuals who currently had asthma. Furthermore, the risk of future asthma was significantly increased by 8-iso levels and particulate matter.

“For the first time in adults, we found associations between long-term exposures to outdoor air pollution, exhaled 8-iso concentration and current asthma,” explained Havet.

“Based on this, we think that 8-iso is a marker related to one of the underlying biological mechanisms by which outdoor air pollution increases the risk of experiencing asthma symptoms, asthma attacks or the need for use of asthma medications.”

Even though air pollution is much lower in western Europe than in regions of Latin America or Asia, the levels are still threatening to respiratory and lung health.

“Efforts should be made to limit air pollution emissions, with more emphasis on moving towards cleaner cities with fewer cars and more efficient public...

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Regular Aspirin Use May Slow COPD Progression

Regular aspirin use was associated with a more than 50% reduction in emphysema/chronic obstructive pulmonary disease (COPD) progression in an elderly cohort over a decade in a longitudinal analysis of data from a large lung study.

The association was seen across aspirin doses and was greatest in older study participants with significant airflow obstruction.

"These findings, along with supportive results in animals, suggest that further study of aspirin and platelet activation in emphysema may be warranted," Carrie Aaron, MD, of Columbia University, New York City, and colleagues wrote in the journal CHEST.

They noted that platelet activation reduces pulmonary microvascular blood flow and contributes to inflammation, which has been shown to be important in the pathogenesis of COPD/emphysema.

"We hypothesized that regular use of aspirin, a platelet-inhibitor, would be associated with slower progression of emphysema-like lung on computed tomography (CT), and slower decline in lung function," the researchers wrote.

To test the theory, they examined data from the Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study, which assessed the percentage of emphysema-like lung below-950 Hounsfield units ("percent emphysema") on cardiac and full-lung CT.

Spirometry was conducted during 2004-2007 and repeated in 2010-2012 in accordance with American Thoracic Society-European Respiratory Society guidelines following the MESA Lung protocol; all exams were reviewed by one investigator.

At the time of the participants' first spirometry measurement, airflow obstruction was defined as pre-bronchodilator FEV1/FVC <0.70 and restrictive ventilatory defect as FVC<lower limit of normal and FEV1/FVC≥0.7.
Regular aspirin use was defined as 3 or more days per week and mixed effects models adjusted for demographics, anthropometry, smoking, hypertension, ACE-inhibitor use, C-reactive protein, sphingomyelins, and scanner factors.

The analysis included 4,257 participants from the MESA Lung Study. Their mean (±SD) age was 61±10 years, 54% were ever-smokers, and 22% used aspirin regularly.

Among the main findings:
On average percent emphysema increased 0.60 percentage points over 10 years (95% CI 0.35 to 0.94).
Progression of percent emphysema was slower among regular aspirin users compared to non-aspirin users (fully adjusted model: -0.34% per 10 years, 95% CI -0.60 to -0.08; P=0.01).

Results were similar in ever-smokers and for doses of 81 mg and...

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