Introduction:
Pneumonia is one of the significant causes of death around the globe. In the United States, around five to ten million people suffer from pneumonia annually. It is estimated that 1 million (approximately) are hospitalized with pneumonia, and about 70,000 die from this disease annually. Post-obstructive pneumonia is a lung infection that is caused due to a blockage in one of the airways. This blockage is seen as a result of the mucus and fluid accumulation in the lung, leading to the infection. Mainly, these obstructions are caused by lung cancer. However, some cases are caused by other reasons. It has been documented that 98 percent of post-obstructive pneumonia are caused by cancer. Postoperative pneumonia is regarded as a preventable complication associated with severe outcomes.
What Are the Causes of Post-obstructive Pneumonia?
During normal respiration, the air is breathed in through the mouth and nose; then, it travels down into the lungs through a windpipe or trachea. After the trachea, the air moves into smaller windpipes or bronchial tubes. The air then travels down deeper into the lungs to smaller tubes called bronchioles. The bronchioles end into the air sacs called alveoli. It is in these alveoli where the gas exchange ultimately takes place. During gas exchange, the oxygen taken in is passed into the bloodstream, and carbon dioxide is breathed out.
Healthy lungs generally have a thin layer of mucus lining the airways. This mucus can trap anything that should not be present in the lungs, like dust or bacteria. The mucus is pushed up and out of the lungs through coughing or sneezing, further clearing the throat.
In post-obstructive pneumonia, one of the airways becomes blocked, usually by a tumor. The airways can be blocked at any point due to the development of abnormal cells inside the airway or by a tumor growing outside or around the airway, exerting pressure on the airway and closing it off.
After the blockage of these airways, the mucus that lines the airways becomes trapped. This mucus consists of bacteria generally occurring in the mouth and airway tracts. These bacteria have the potential to grow after becoming trapped in the airway. However, bacteria do not cause all post-obstructive pneumonia, and it can be difficult to determine the causative organism.
What Are the Symptoms of Post-obstructive Pneumonia?
The symptoms of post-obstructive pneumonia can be confused with the symptoms of typical pneumonia, which are fever, cough, or shortness of breath.
However, there can be some other symptoms with post-obstructive pneumonia that might not occur with typical pneumonia. These can include:
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Chest pain.
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Poor appetite.
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Weight loss.
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Coughing up blood (hemoptysis).
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Wheezing.
How Is Post-obstructive Pneumonia Diagnosed?
Diagnosis of post-obstructive pneumonia is similar to the diagnosis of typical pneumonia and usually starts with a physical exam. In case of symptoms like cough and fever, the individual must get checked by a healthcare provider.
The healthcare provider evaluates the patient's condition to find the cause of these symptoms. Based on the symptoms and examination, a course of antibiotics is prescribed. In patients with post-obstructive pneumonia, a short course of antibiotics will not treat the infection completely. If symptoms exist even after the antibiotic course, the patient must return for a follow-up visit to the healthcare provider.
When antibiotics are not effective in treating the infection, further imaging tests, like a chest X-ray or a computed tomography (CT) scan, might be required to get a clear picture.
Other diagnostic tools can include:
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Bronchoscopy.
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Endobronchial ultrasound.
These exams involve a long, thin tube with a light and camera at the end that is inserted into the airway. The end of the tube is passed down into the tiny airways of the lungs to examine the blockages. During these procedures, biopsies (tissue samples to be examined in a laboratory) of any suspicious areas might be taken. Further, fluid samples can also be taken to determine the source of infection.
How Is Post-obstructive Pneumonia Treatment?
The treatment for post-obstructive pneumonia is often initiated with antibiotics, generally lasting for a few weeks. The infection must be cured and resolved before the healthcare provider will proceed with further treatments. The treatment involves the following steps:
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Understanding the Underlying Cause: The primary focus of treatment is to remove or alleviate the obstruction causing the pneumonia. This may involve surgery, radiation therapy, or chemotherapy, depending on the underlying cause.
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Antibiotics: Antibiotics are prescribed to combat the bacterial infection accompanying post-obstructive pneumonia.
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Bronchodilators: Medications like bronchodilators may help open the airways and improve breathing.
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Supportive Care: Proper hydration, rest, and pain management can contribute to the overall recovery of the patient.
If the post-obstructive pneumonia is due to cancer or a tumor, it might require procedures to remove the tumor that is blocking the airways once the infection has been resolved. These procedures include the following:
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Surgery: The affected part of the lung is removed through surgery. However, this is only performed when there is a possibility that the underlying cancer can be cured and not in cases where the cancer is widespread.
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Radiation: External beam radiation can be used in patients where more invasive procedures cannot be performed. This helps to shrink the tumor and allows the airway to open again.
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Laser Bronchoscopy: A tube is inserted into the airway to the blockage level in a laser bronchoscopy. A laser is then used to burn the tissue, blocking the airway and allowing it to open.
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Stent Placement: If an airway is obstructed by a tumor around the outer boundaries of the airway, a stent can be placed. A stent, made out of silicone or metal, is placed inside the compressed area. The stent provides support to the airway from the inside, keeping it open in spite of the force from the outside. This helps the airway to remain open.
Conclusion:
Post-obstructive pneumonia is a serious condition that requires prompt diagnosis and intervention. Understanding the underlying causes, recognizing symptoms, and getting prompt medical attention is of utmost importance to achieve effective management. Advances in medical technology and a multidisciplinary approach to treatment offer hope for improved outcomes for individuals affected by post-obstructive pneumonia. If an individual suspects any respiratory issues or experiences persistent symptoms, it is essential to consult a healthcare professional for a complete evaluation and proper management.
