Health Matters: What causes acute respiratory distress?
Q. A young man in our community nearly drowned recently. After he was rescued, he initially seemed fine, but then got very sick when his lungs filled with fluid while he was in the hospital. Fortunately, he eventually recovered completely, but what happened to him?
A. The scenario you describe is typical of what we call the acute (previously adult) respiratory distress syndrome, or ARDS. Clinical features associated with the condition first were described almost 200 years ago, but realization of the specific characteristics and naming of ARDS did not occur until 1967. ARDS occurs most commonly when an infection occurs in the lungs or elsewhere in the body, after smoke inhalation or major trauma, following drug overdose and after near-drowning. In most cases the problem is that the lungs become stiff and fill with bodily fluids, making it difficult for the lungs to perform their primary role, which is to transfer oxygen into the bloodstream. It is a common problem, especially in sick patients, occurring in one out of 10 patients who are in an intensive care unit and upwards of one in four patients who need breathing tubes. Initially, ARDS was a nearly uniformly fatal disease, but advances in medical care have lowered the overall mortality rate to about 25 percent. Not only have we learned from experience what we should do in treating patients with ARDS, but we've also learned what we shouldn't do. For example, there is no specific drug that has been shown to lower mortality in patients with ARDS, meaning we have learned to rely on treatments that don't involve pharmaceuticals. Unfortunately, even those who survive often face long-term problems with lung and brain function. So it's good news that your neighbor recovered completely.
Q. There seem to be a lot of bees and yellowjackets around lately, and I'm afraid of getting stung. But if I do, what are my treatment options?
A. First of all, remember the old adage that "an ounce of prevention is worth a pound of cure." Insect avoidance is an important basic concept. But sometimes you get an insect sting (from yellowjackets, wasps, honeybees, and fire ants) despite the best avoidance efforts. The body's allergic reaction to the venom often is worse than the sting itself, and can be mild or severe. For a small, mild sting marked by a small area of skin with red and itchy swelling, no treatment may be required. For larger and more severe stings, an oral antihistamine such as cetirizine (brand name Zyrtec) and/or a cortisone cream applied to the inflamed area may help. A prescription for oral steroids (prednisone) may be needed for large and more severe reactions. And a minority of stings are so severe that the person's blood pressure falls and they may have trouble getting air in and out of their lungs due to marked swelling of the throat. This condition, called anaphylaxis, requires injection of a medicine called epinephrine (which is available in a portable auto-injector form that susceptible patients can carry with them). Fortunately, desensitization treatment by an allergist is often effective in patients who have had a prior severe or anaphylactic reaction to an insect string.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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