Preventing lung diseases

Preventing occupational lung and respiratory diseases is the most significant way to reduce the number of deaths from these illnesses. The most effective way to prevent these diseases is to avoid inhaling the substances that cause them. Limiting or eliminating exposure to these irritants is the only way to decrease their effects on the body. Some preventive measures recommended by the National Heart, Lung and Blood Institute (NHLBI) include:

  • Wear protective gear such as facemasks, respirators, or other garments that will prevent inhalation of dangerous airborne particles.
  • Follow specific government guidelines in removal or repair of
    dangerous substances such asbestos.
  • Do not smoke cigarettes as the use of tobacco can increase
    the risk of developing lung and respiratory disease.
  • Make routine visits to your physician to have lung function evaluated
    with spirometry.
  • Become familiar with any dangerous substances that may be present in the workplace and know the risks associated with them.

The lungs and the tissue leading to them are the body’s first organs to come into contact with outside air. The lungs are susceptible to many irritants due to the constant breathing in and out. The particles in the air can cause damage and leave individuals permanently disable and sometimes lead to death. The diseases caused by these particles are almost entirely preventable. Using the measures listed above as well as following workplace guidelines may help worker’s avoid these life-changing diseases.

Government agencies also help in the prevention of occupational disease by posing regulations on workplace safety. In 1970 the government established laws that created two national health agencies. The first, the National Institute for Occupational Safety and Health (NIOSH), was formed to oversee and research safety in workplace activities. This agency was established within the U.S. department of Health and Human Services. The second agency was established within the U.S. Department of Labor. The Occupational Safety and Health Administration (OSHA) was designed to set government standards for health and safety in the workplace and also enforce these standards.

NIOSH has created the National Occupational Research Agenda (NORA) which is a comprehensive list of areas that address workplace dangers. This agenda explores toxicology, identifies emerging technology dangers and evaluates how the combinations of substances in the workplace may effect workers. The reports garnered from this research may help to provide insight into new and dangerous substance as they arise.

Occupational irritants are found worldwide and the knowledge of their danger has helped to decrease the occurrence of disease in many industrialized nations. These developed countries such as the United States have begun major prevention programs. Unfortunately, less developed nations are just beginning to see the effects of imported, dangerous materials. It is the hope of world organizations such as the World Health Organization and the International Labor Office to begin prevention programs worldwide to help stop these diseases.

Occupational diseases

Occupational diseases are those illnesses that occur due to exposure to irritants in the workplace. Occupational illnesses may occur instantaneously due to exposure to toxic chemicals or fumes or may take years to develop due to long-term exposure. Many individuals today are faced with respiratory disease such as adult asthma, chronic obstructive pulmonary disease (COPD) and emphysema. These diseases are life changing and can often be fatal. According to the Center for Disease Control and Prevention (CDC) many of these airway and lung diseases are being contracted on the job. The CDC states that almost 30 percent of adult asthma and COPD may be caused by irritants in the workplace. Over 20 million American workers may be exposed to these dangerous substances each year. In addition to respiratory diseases, individuals may also be exposed to substances that cause lung diseases, such as malignant mesothelioma, obstructive lung disease, lung cancer and a host of other serious illnesses. The American Lung Association cites occupational lung disease as the number one cause of workplace illness. Not all occupational diseases lead to death but a significant amount greatly diminish quality of life.

Many jobs require employees to work in close proximity to dangerous substances. These substances include asbestos and coal dust, which are well known to cause respiratory and/or lung diseases. In addition to these substances, there are many lesser-known irritants that can also be harmful after long-term exposure. Even short-term exposure to some gases or fumes can have long lasting and damaging effects.

How to Manage Late Effects of Chemotherapy Drugs

Once a cancer patient’s treatments have ended, there is still a chance that he or she can experience side effects. Some side effects can continue after treatment or surface months or years after treatment. There is not a lot of concrete information that is known about cancer treatment side effects, but they can vary by treatment type and individual circumstances. 
 
Physicians aren’t sure why these effects occur late. Some doctors think the side effects may have been there during treatment, but they weren’t noticed because the body was counteracting them and after treatment the body no longer does this, thus they begin to emerge later. 
 
Side effects that are apparent during cancer treatment can continue to last months or years afterward. Most long-term effects reduce over time or completely disappear. An example of a long-term side effect is peripheral neuropathy. It can occur during chemotherapy treatment and continue months or years after treatment has been completed. 
 
What Chemotherapy Treatments Cause Late Side Effects? 
 
In general, chemotherapy treatments are more likely to cause late effects than other types of cancer treatments. Not all cancer patients may experience long-term or late effects and different chemotherapy drugs may cause various effects. 
 
Some of the following are long-term side effects from chemotherapy treatment: 
 
 

  • fatigue 
  • neuropathy 
  • chemobrain 
  • heart failure 
  • kidney failure 
  • infertility 
  • liver problems 
  • menopausal symptoms 

 
Some of the following are late side effects from chemotherapy treatment: 
 

  • cataracts 
  • osteoporosis 
  • chemobrain 
  • reduced lung capacity 
  • lung disease 
  • infertility 
  • liver problems 
  • second primary cancers 
     
     
     

More Information About Managing Chemotherapy Side Effects 
 
If cancer patients need more information, or have questions on how to manage chemotherapy side effects, they can contact The American Cancer Society at 1-800-ACS-2345, or read an online booklet, Understanding Chemotherapy: A Guide for Patients and their Families, at the following web address: http://www.cancer.org/docroot/ETO/ETO_1_5x_Guide_for_Patients_and_Families.asp 
 

Rash as a Chemo Side Effect

Chemotherapy drug treatment can cause a patient to experience rashes on the back, chest, arms, neck or face that may look like a rosacea or acne type condition. A patient usually experiences rash side effects that are mild to moderate. Rash side effects do come with an infection risk factor. In some cases if the rash is serious, the treatment drugs may be reduced, delayed or terminated.

Drugs That Cause Rash

Some of the medications that increase the likelihood of a rash are Tarceva (erlotinib) and Erbitux (cetuximab). They may cause an acne-like condition that arises in the second week of the cancer treatment, but may start to diminish by the fourth week of treatment. The rash goes away once the treatment has been completed.

These medications are directed toward the epidermal growth factor receptor (EGFR) and inflammation occurs that often causes an acne-like skin reaction.

Drug Treatments to Reduce Rash Side Effects

There are no real firm standards on what can be used to treat rashes for chemotherapy patients; however, following are some medications used to help reduce rash side effects during chemotherapy drug treatment:

– antihistamines such as Benadryl and Atarax to lessen itching
– topical corticosteroids
– antibiotics (oral or topical)
– Elidel being researched to control EGFR-related rash side effect

Why do the side effects occur in specific parts of the body?

Healthy cells in certain parts of the body are especially sensitive to chemotherapy drugs. The parts of the body that seem to be prone to side effects are the parts that have rapidly dividing cells. Chemotherapy drugs attack these cells and can result in various side effects based on the drug type, dose and route in which the patient receives the drugs.

The following cells are prone to side effects:

  • the bone marrow cells (which makes blood cells)
  • hair follicles cells
  • cells that line the mouth and throat
  • cells that line digestive system

Chemotherapy treatments are normally given in a group of sessions. The sessions are followed by a period of rest. The chemotherapy sessions kill the cancer cells and the rest periods allow the healthy cells to recover.

Constipation

Chemotherapy
drug treatment can cause a patient to experience constipation, or the
uncomfortable passage of hard, dry stools that are infrequent. Some
symptoms include bloating, cramping, increased gas and pain. About 50
percent of cancer patients experience constipation. Other side effects
can occur from this condition such as decreased appetite and nausea.

Drugs That Cause Constipation

Some of the medications that increase the incidence of constipation are
opioid pain medications and chemotherapy drugs such as vincristine and
vinblastine.

Other Causes of Constipation

Other than medications there are other factor that can lead to an increase in the likelihood that a patient experiences constipation such as depression, decreased fluid or food intake, dehydration, low fiber diet and lack of physical activity.   

Drug Treatments to Reduce Constipation 

Following are some medications that may help reduce constipation during chemotherapy treatments:

  • Psyllium (Metamucil) 
    – Docusate sodium (Colace)   
    Bisacodyl (Dulcolax)  
    – Sorbitol and sodium phosphate (Fleet’s enema) 
    – Glycerin suppository 
    – Magnesium hydroxide (Milk of Magnesia)  
    Senna (Senokot)  
    – Lactulose (Chronulac)  
    – Magnesium citrate 

Non-Drug Treatments to Reduce Constipation 

Following are some non-drug methods to help reduce the incidence of constipation during chemotherapy drug treatment: 

  • stay physically active
  • try to drink at least 3 quarts of fluids per day
  • try to eat high-fiber foods
  • patients to tell their doctor if they don’t have bowel movement for more than three days

Diarrhea

Chemotherapy drug treatment can cause a patient to experience diarrhea, or the passing of an increased amount of a watery or loose stool multiple times throughout the day. Some symptoms include bloating, cramping, increased gas and pain. About 3 out 4 cancer patients experience diarrhea during chemotherapy treatment due to the attack on the cells in the digestive tract.

Drugs That Cause Diarrhea 

Some of the medications that increase the incidence of diarrhea are
dactinomycin, doxorubicin, docetaxel, methotrexate, irinotecan,
5-fluorouracil, antibiotics or antacids.

Also the dose of the chemotherapy drug can play a role in whether or not a patient experiences diarrhea.

Diarrhea
can lead to dehydration and is a common side effect of irinotecan
(CPT-11). Patient’s should tell a physician when diarrhea occurs and
follow his or her instructions to stop the condition.

Other Causes of Diarrhea

Other than medications there are other factors that can lead to an increase in the likelihood that a cancer patient experiences diarrhea such as
stress, anxiety, food allergies, when a patient receives radiation and
chemotherapy simultaneously, stomach tumor, nutritional supplements and
the length of treatment.

Non-Drug Treatments to Reduce Diarrhea

Following are some non-drug methods to help reduce the incidence of diarrhea during chemotherapy drug treatment


  •  
    – stay physically active 
    – try to drink at least 8-10 glasses of fluids per day (i.e. water, Gatorade, broth) 
    – try to eat small portions of low-fiber foods frequently (i.e. banana, rice, bread, chicken) 
    – avoid greasy, fatty, fried foods 
    – avoid vegetables and fruits 
    – limit caffeine beverages and extremely hot or cold beverages 
    – avoid whole grain bread, cereal, nuts, popcorn 
    – avoid gas-forming foods and beverages 
    – avoid alcohol, lactose-containing products and supplements

Over-the-Counter Medications to Reduce Diarrhea

Following are some over-the-counter medications to help reduce the incidence of diarrhea during chemotherapy drug treatment: 

  • Kaopectate®II caplets 
    Maalox®anti-Diarrheal caplets  
    Loperamide (Imodium®)  
    Pepto® Diarrhea control (follow instructions on container)

Pain

It has been shown that almost 90 percent of cancer patients suffer some type of pain during or after cancer treatments. Fifty percent of patients suffer some sort of chronic pain.

Cause of Pain

Chemotherapy drug treatments can cause different types of pain such as, acute pain that comes on and lasts a short period of time, or chronic pain, which is continuous and lasts more than six months. The pain that patients experience can occur when tumors press on nerves.

There are various pain management treatments that can help with short or long-term pain.

Some medications are constantly administered for long-term, chronic pain and are usually long-acting so that they are always in the body to help counteract the pain. Other medications, called short-acting medications, are used for acute pain or something called “breakthrough” pain, which is a short, brief, yet severe attack of pain.

Physicians may have to try different pain relief medications before finding a balance between managing the pain and the reducing the related medication side effects.

Drug Treatments for Pain

Physicians use morphine for chronic pain relief. Patients may experience side effects from morphine such as constipation, drowsiness, nausea and sleepiness. These side effects can be managed with other medications.

Opioids are medications that are also used to help relieve pain. They are drugs that contain natural opiates and synthetic narcotics. These medications are some of the most effective and are often used for cancer-related pain management. These drugs attach to opioid receptors, or specific proteins, that are in the brain and spinal cord. In the spinal cord, they block pain messages from reaching the brain. In the brain, they change how the body interprets or experiences the pain.

Another type of high-dose medication that is applied as a patch is called Duragesic. It continuously administers opioids in high-doses so that it can relieve pain up to 72 hours. A more recent form of this patch has been released and contains a potent semisynthetic opioid called buprenorphine.

Another recent pain management drug treatment is Prialt (ziconotide). It is a potent drug and stops pain by binding to calcium ions. It has different side effects than opioids such as headaches and dizziness. In some rare cases other side effects may be hallucinations, delirium and coma. The patient receives the drug through a pump that is surgically implanted and goes directly into the spinal fluid.

Neuropathy

Chemotherapy drug treatments can cause neuropathy, or injury to the peripheral nerves. These consist of motor nerves that help with movement and muscle tone and sensory nerves that help with temperature, pain and touch. The symptoms of neuropathy depend on the nerve type that is affected.  

Symptoms of motor nerve damage include muscle weakness, spasms, cramps, and possibly loss of balance and coordination. Sensory nerve damage can result in pain, numbness, tingling (burning, freezing sensation), and extreme sensitivity to touch. 

If peripheral neuropathy goes untreated, it can develop into permanent damage to nerves, tissues and muscles. Proper treatment can help reduce the risk of irreparable damage and other serious consequences. 

Drugs That Cause Neuropathy

Patients that receive vinca alkaloids (anticancer drugs that stop cancer cell growth by inhibiting cell division) are susceptible to develop neuropathy during their treatment. The condition may develop weeks, month or years even after treatments end. The symptoms may wane as the nerves heal.

Some chemotherapy drugs that are known to cause neuropathy are cisplatin, paclitaxel, oxaliplatin, vincristine, thalidomide and bortezomib. Patients that are already experience nerve damage by other conditions such as diabetes or excessive alcohol use are more prone to develop chemotherapy drug related neuropathy. 

Drug Treatments for Neuropathy

Physicians are investigating some drugs such as anticonvulsants (used in the treatment of epileptic seizures) and antidepressants to help treat the symptoms of neuropathy.

Doctors have found these drugs helpful in managing the condition even though the Food and Drug Administration has not given approval of these drugs for neuropathy treatment. 

Anticonvulsants such as Neurontin have been administered to patients with the condition. Doctors prescribe a low dose to begin and increase as time goes on to help manage pain.  

Some antidepressants used to manage neuropathy symptoms are nortriptyline and amitriptyline.  

Other Non-Drug Treatments for Neuropathy

Some of the following methods can be used in combination with drug treatment or alone to help manage symptoms of neuropathy: 

– massage 
– herbs 
– acupuncture 
– physical therapy to help strengthen muscles 
– occupational therapy to help with assistance of daily tasks 

Another technique is to use transcutaneous electrical nerve stimulation (TENS) to help stop pain signals from going to the brain by using painless electrical impulses by placing electrodes on the skin. TENS seems to be more effective with acute pain and less effective with chronic pain. 

Neutropenia in mesothelioma patients

Chemotherapy drug treatments reduce the number of neutrophils, also known as white bloods cells that protect the body against infection. This causes a condition known as neutropenia. Cancer patients that suffer from neutropenia have an increased risk of bacterial infections and could be fatal if left untreated. Some symptoms of neutropenia include body aches, fever and fatigue. Doctors normally find neutropenia when conducting a complete blood count (CBC) to determine the number of red and white blood cell counts.

Physicians determine the risk of neutropenia by calculating the neutrophil count, called the absolute
neutrophil count (ANC). The absolute neutrophil count is calculated by
multiplying the total white blood count by the percent of neutrophils.

The following scale shows the risk of infection based on the ANC:

Risk of Infection based on Absolute Neutrophil Count (ANC)

ANC greater than 1500: No increased risk of infection

ANC 1000-1500: Slight increase in risk of infection

ANC 500-1000: Moderate increase in risk of infection

ANC 100-500: High risk of infection  

ANC less than 100: Extremely high risk of infection 

Drugs That Cause Neutropenia 
 
Overall, most chemotherapy drugs can cause neutropenia because they tend to lower the number of neutrophils. They grow quickly but only survive three days.  
 
Drug Treatments for Neutropenia 
 
Physicians treat cancer patients that suffer from neutropenia with a drug called Neupogen (filgrastim). This substance recreates blood growth factors that boost the number of white blood cells. It is given by injection every five to seven days, but due to the inconvenience of this frequency, another type of drug called Neulasta (pedfilgrastim) was developed. It lasts longer and needs to be administered every 21 days. These drugs have side effects of their own that causes bone and joint pain.

Other Precautions to Reduce Risks of Infection

The following precautions should be taken by patients with neutropenia to reduce risk of infection:

  • Avoid people that might be sick with a cold, flu or infection
  • Keep skin moist to prevent dry, cracking skin
  • Don’t scratch sores and keep them clean with antiseptic and a bandage
  • Don’t eat raw foods
  • Keep mouth clean, brush regularly and use alcohol-free mouthwash

Fatigue as a side effect

Chemotherapy drug treatments can be effective, but they also seem to be linked to intense fatigue. Drugs that often cause cancer-related fatigue are vinblastine, cisplatin and vincristine.

The severity of fatigue may vary by individual, but almost 90 percent of cancer patients experience some level of fatigue related to cancer treatment at some time during therapy. It is also known that the symptoms from fatigue can last for months or years after cancer treatment.

Specifically, fatigue can be caused by cancer-related anemia or low thyroid function and can intensify with emotional distress or depression related to the cancer treatment. A patient with fatigue may feel weak, forgetful, have decreased energy level and an inability to concentrate.

Drug Treatments to Reduce Fatigue

Physicians treat cancer patients that suffer from fatigue in a similar way to patients with anemia. Doctors use drugs that produce hormone and stimulants such as Ritalin (methylphenidate) and Provigil (modafinil).

Other Treatments to Reduce Fatigue

None-drug treatments such as exercise, diet and conserving energy have been shown to reduce fatigue.

Exercise

Doctors put their patients on a low-intensity exercise regimen to avoid the loss of too much muscle mass that can lead to fatigue more easily than someone that does some sort of physical activity. Too much high-intensity exercise is not good for cancer patients since it can put the immune system at risk.

Diet

Cancer patients can monitor their diet to help reduce fatigue. If a patient doesn’t maintain the proper nutrition by eating the right foods, this will contribute to fatigue. It is recommended that a cancer patient gets at least 15 calories per pound of his or her body weight. Proper amounts of protein are also important to help rebuild and repair body tissue. The recommended amounts of protein are 0.5 to 0.6 grams for every pound of body weight. Patients should have a minimum of 64 ounces of fluids per day and limit their intake of alcoholic and caffeine beverages. It is recommended to supplement their diet with a multivitamin that gives them 100% of the recommended daily nutrients.

Conserve energy

Cancer patients should organize their tasks ahead of time and try to schedule rest periods to help save energy throughout their day. The following are some recommendations to conserve energy:

– Take time in the day to rest
– Take multiple short naps or breaks instead of one long break
– Save energy for important tasks
– Get help to delegate some tasks
– Moderate pace is better than rushing through tasks

Oral Mucositis – Sores in Mouth and Throat

Some chemotherapy drugs can cause sores in the mouth or throat because they inhibit the replacement of the healthy cells. The condition that causes sores in the mouth is known as stomatitis, and a comparable condition in the throat is known as pharyngitis.  

The lining of the mouth starts to become pale and dry. As time goes on, the mouth and throat may become red, sore and inflamed. The patient may have trouble eating, talking or swallowing. Eventually, the condition can lead to painful, bleeding ulcers and possibly infection. This condition normally develops approximately 5 to 14 days after chemotherapy treatment has taken place. These conditions eventually heal once chemotherapy treatment has ended. 
 
It has been determined that up to 75 percent of patients who receive high-does chemotherapy get oral mucositis and approximately 40 percent of patients that receive standard-dose chemotherapy experience this side effect. 

  
Drugs That Cause Oral Mucositis 
 
Some chemotherapy drugs such as methotrexate and 5-FU have shown to cause a higher incidence of oral mucositis than some others. If the patient is treated early, it can lessen the severity of the symptoms. 
 
Treatments to Reduce and Relieve Incidence of Oral Mucositis 
 
There are some common none-drug treatments to help reduce the severity of oral mucositis. 

Following are some steps that can be taken to help the healing process: 

– Keep the mouth clean and moist 
– Brush teeth with a soft toothbrush or swab 
– Stay away from mouthwashes; rinse with salt or baking soda solutions 
– Stay away from foods and juices that are acidic 

There are some medications that have been recommended and administered to cancer patients to help alleviate pain from oral mucositis. They include the following: 
 
– Tylenol liquid (acetaminophen) – helps relieve pain but doesn’t heal sores 
– Kepivance (palifermin) – this drug is used for severe cases of oral mucositis in patients with  
  blood cancers 
– Gelclair (hyaluronate)- relieves pain by creating a protective barrier and coating the oral  
  mucosa 
– Saforis (glutamine) – a new drug known to be effective in preventing and treating oral mucositis