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Friday 11 February 2022

can vicks vaporub cause pneumonia?

Pneumonia - causes, symptoms, diagnosis, treatment, pathology



What does Vicks do for your lungs?

Results showed that Vicks exposure increased mucus secretion in both normal and inflamed airways. In addition, the studies showed that exposure to the product decreased the rate by which mucus was cleared from the trachea.

Why does Vicks Vapor Rub work so well?

Camphor and menthol produce a cooling sensation

Using Vicks VapoRub on your feet or other areas of your body has a cooling effect. This is mainly because of the camphor and menthol. The cooling sensation of the vapor rub may be pleasing and temporarily help you feel better.


Why does putting Vicks on your feet stop coughing?

Given that feet contains lots of nerves, Graedon speculates that sensory nerves in the soles of the feet may respond to stimulation with Vicks VapoRub: The [brain’s] cough center is right next to the spinal cord.

Can you use Vicks every night?

Q: How often can I use Vicks VapoRub? A: For cough suppression, Vicks VapoRub may be used up to 3 times daily or as directed by your doctor. Simply rub a thick layer on your chest and throat. For muscle/joint minor aches and pains, Vicks VapoRub may be applied to the affected area not more than 3 to 4 times daily.

Is inhaling Vicks bad for you?

The bottom line. It’s not safe to use Vicks VapoRub inside your nose as it can be absorbed into your body through the mucus membranes lining your nostrils. VVR contains camphor, which can have toxic effects if absorbed into your body. It can be especially dangerous for children if it’s used inside their nasal passages.

Can you put Vicks on your chest with Covid?

Long story short, the petrolatum base of VapoRub, when inhaled, can travel to the lungs, where it collects and causes ground-glass opacities — a type of damage also associated with COVID-19. If you’re feeling ill from any respiratory ailment, using VapoRub on your chest or in a vaporizer may soothe your symptoms.

Will Vicks Vapor Rub help a dry cough?

Vicks VapoRub contains 2.6% menthol to help stop constant coughing fast. Vicks VapoDrops are also an effective remedy for coughs. Allow 2 drops to dissolve slowly in your mouth to help stop constant coughing. Although Vicks products cannot cure a cough, they can help stop constant coughing.

Is Vicks supposed to burn your chest?

This product can cause a mild cooling or burning sensation wherever it is applied. If this sensation is painful or causes severe discomfort, wash the treated skin area with soap and cool water. Do not heat the product before use or it may cause burns.

What happens if you put Vicks in your nose?

Topical camphor absorbed through mucous membranes or broken skin also can be toxic. That’s why you should never put VapoRub in or around the nostrils — especially a small child’s nostrils. And if VapoRub gets in your eye, it can injure your cornea.

Can Vicks VapoRub cause pneumonia?

We report a case of exogenous lipoid pneumonia from chronic, extranasal use of petrolatum ointment (Vicks VapoRub in this case) for nasal decongestion in a young woman, presenting with cough, dyspnea and fever. Exogenous Lipoid pneumonia is a rare condition, underdiagnosed and is more prevalent in adults.

Will Vicks Vapor Rub help with pneumonia?

The doctor was surprised and maybe amused when I mentioned this home remedy. A. We are impressed that Vicks VapoRub on the soles of the feet actually helped a serious cough that signaled pneumonia. We do NOT recommend toughing it out with a home remedy as long as your hubby did.

Why does Vicks go on your chest?

When you’re congested, putting VapoRub on your chest can help you feel like your breathing has improved. It does this by releasing menthol vapors that feel cooling to your nasal passages. This tricks your brain into thinking you are breathing more easily.

How do you use Vicks to clear your nose?

For example, place your index fingers on both sides of your nose where the nose and cheek meet (with one finger on each side), and apply moderate pressure for 2 to 3 minutes. You can also use your index fingers to apply pressure on the bridge of your nose, right between your eyebrows; hold for 2 to 3 minutes.

Is it safe to inhale Vicks in hot water?

For adults and adolescents aged 12 years and over, Vicks vaporub should be rubbed liberally on the chest, throat and back underneath loose clothing to allow the vapour to be inhaled. Alternatively, two teaspoonfuls can be melted in hot (not boiling) water to use as a steam inhalation.

Why Vicks is banned in some countries?

Why is Vicks banned in many countries except India? Answer (1 of 12): Vicks VapoRub is banned in America as it is declared not good for health it can create Asthma, TB etc. It is declared as Toxic by WHO. VapoRub is currently manufactured and packaged in India and Mexico.

What else can Vicks VapoRub be used for?

Some of the other uses of Vicks VapoRub are as follows: Treating foot conditions such as cracked feet and athlete’s foot (a type of fungal infection of the feet) Managing stretch marks. Treating skin conditions such as acne and eczema.

How long should you inhale Vicks for?

Inhale slowly and deeply through your nose for at least two to five minutes.

Is Vicks VapoRub good for toenail fungus?

Although designed for cough suppression, its active ingredients (camphor and eucalyptus oil) may help treat toenail fungus. A 2011 study found that Vicks VapoRub had a “positive clinical effect” in the treatment of toenail fungus. To use, apply a small amount of Vicks VapoRub to the affected area at least once a day.

Can you put Vicks on your upper lip?

Fix chapped lips

The menthol in Vicks is very strong, so you shouldn’t spread your lips with a thick layer, but a small amount applied to sore, dry or cracked lips can help to repair the skin, leaving you with a happy smile again. Just be careful not to ingest it!

How to Get Rid of Pneumonia Naturally - Home Remedies



Is Steam good for your lungs?

Conversely, steam adds warmth and moisture to the air, which may improve breathing and help loosen mucus inside the airways and lungs. Inhaling water vapor can provide immediate relief and help people breathe more easily.

Can I put Vicks on my feet?

Does putting Vicks on your feet work? Vicks VapoRub is a popular product for helping with the symptoms of a cold. Applying Vicks to the throat and chest can help with symptoms such as a blocked nose. Applying Vicks to the feet, however, is unlikely to have any effect.

We report a case of exogenous lipoid pneumonia from chronic, extranasal use of petrolatum ointment (Vicks VapoRub in this case) for nasal decongestion in a young woman, presenting with cough, dyspnea and fever. Exogenous Lipoid pneumonia is a rare condition, underdiagnosed and is more prevalent in adults.


Is VapoRub bad for lungs?

The salve is widely used to relieve symptoms of colds and congestion, but there are few data supporting an actual clinical benefit, according to Rubin. Vicks has been reported to cause inflammation in the eyes, mental status changes, lung inflammation, liver damage, constriction of airways and allergic reactions.


Which fruit is good for pneumonia?

The vitamin- C rich citrus fruits like oranges, berries, kiwi help in boosting the immune system and thus promote a speedy recovery. They also contain antioxidants that protect the body against foreign agents.


Is lemon water good for pneumonia?

While it is an excellent way to prevent colds, you can always drink warm lemon water during a cold to help loosen congestion and shorten the duration of symptoms. Drinking lemon water also promotes healthy kidneys, respiratory system, and cardiovascular system. It has also been known to fight pneumonia.

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What vitamin is good for pneumonia?

Research studies suggest that vitamin C may prevent and treat pneumonia. Zinc is an essential mineral that is found in almost every cell of the body.


Does hot showers help pneumonia?

Inhaling warm, damp air may ease breathing and keep the throat from tightening. Breathing in the steam from a shower or breathing over a warm cup of tea may help.


Does drinking water help pneumonia?

Drink, drink, then drink some more. Fluids hydrate the body, loosen mucus in the lungs, and help bring up phlegm. Take in lots of water.



What is the strongest antibiotic for pneumonia?

Macrolides. The best initial antibiotic choice is thought to be a macrolide. Macrolides provide the best coverage for the most likely organisms in community-acquired bacterial pneumonia (CAP). Macrolides have effective coverage for gram-positive, Legionella, and Mycoplasma organisms.

Patients commonly use petroleum-based over the counter remedies to alleviate symptoms of rhinitis. But such medicines carry risks of often under-appreciated side effects. In a recent report, researchers described a case in which a patient developed exogenous lipoid pneumonia (ELP) as a side-effect of a long-term petroleum-based remedy.


The case study reveals an 85-year-old patient with a history of recurrent allergic rhinitis events since childhood who applied an over-the-counter mentholated mineral ointment decongestant every day to her chest, palms and feet, and aspirated through the nose for approximately 50 years. At the time of the visit the patient had no signs or symptoms of respiratory disease. A chest radiograph revealed an irregular mass-like-lesion in the right lower lobe.


A thoracic computed tomographic (TCT) scan reveled the presence of intrapulmonary lipid (fat) leading doctors to recommend that the patient stop using Vicks VapoRub. Intranasal corticosteroids were then prescribed for the management of the rhinitis. Twenty-six months after the patient stopped using the petroleum-based remedy, the size of the mass had decreased and the pathologic pattern of the opacities had diminished as well.


The research paper, “Exogenous lipid pneumonia related to long-term use of Vicks VapoRub® by an adult patient: a case report,” was published in BMC Ear, Nose and Throat Disorders.


ELP is a rare condition that results from the aspiration or inhalation of material of animal, vegetable or mineral origin. The principal culprit in ELP is the inhalation of hydrocarbons found in petroleum that accumulate in the alveoli and ultimately lead to the onset of an inflammatory reaction. Most ELP cases stem “from the use of oil-based laxatives for the treatment of constipation, or from nasal instillation of oily products, including petroleum ointment products such as Vaseline or Vicks VapoRub® for relief of chronic rhinopharyngeal diseases,” according to the study.


ELP is difficult to diagnose, as its clinical and radiological presentations are nonspecific and mimic many other diseases. High-resolution computed tomography (CT) is the best imaging technique to accurately diagnose ELP. The presence of fat in mass-like lesions is a diagnostic feature of ELP.

Pneumonia | Discharge Instructions | Nucleus Health



“Physicians need to be aware of this chronic adverse effect and discourage the use of mineral oil and ointment. The ability to recognize radiological manifestations of ELP can help establish an early diagnosis and start timely intervention,” the researchers concluded.

 Let’s be honest, most of us regularly use Vicks Vaporub for a lot of things.


Have a cold? No problemo, just slap some Vicks on. Duh.


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It’s also a godsend when I have cough, I just rub the Vaporub on my chest and I can sleep like a baby without coughing my lungs out.


WERBUNG


But I have to admit that I also use VapoRub for other things.. like applying it under my nose. Apparently, this can cause pneumonia.


WERBUNG



Image: Pinterest

US Doctor Claims Rubbing Vicks Under Nostrils Can Cause Pneumonia

A Facebook post by a doctor from the United States named Dr Hawa Edriss warned that doing the above might be detrimental to our health.


Personally, applying VapoRub under my nose eases any nasal congestions I have.


However, Dr Edriss says that it could cause pneumonia. She recounts the experience of a middle-aged man who applied VapoRub regularly under his nose to help him with his nasal congestions.


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Oops, that sounds like me.



Image: Facebook (Hawa J Edriss)

He did it for more than 10 years and was always having trouble with his respiratory system.


Hence, he was in and out of health care centres, before he came to Dr Edriss for help. Finally, he was diagnosed with pneumonia.



Apparently, a lot of people seem to misuse Vicks VapoRub because the post garnered a lot of shares. 23,000 shares to be specific.


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Dr Edriss had treated this man and diagnosed him with Exogenous Lipoid Pneumonia.


Caused By Breathing In Mineral Oils

But what exactly in the Vicks VapoRub caused it? Before I explain, let me define what is Exogenous Lipoid Pneumonia.


Exogenous Lipoid Pneumonia (ELP) is defined by Dr Edriss as a rare form of pneumonia caused by inhaling a fatty substance like animal fat, vegetable oil or mineral oils.


ELP shows up on X-rays as fast as 30 minutes after inhalation. The person affected will then develop black spots within 24 hours of the last inhalation.

Use of petroleum-based over the counter remedies such as Vicks VapoRub to alleviate symptoms of rhinitis is common and can be effective, but carries under-appreciated risks of adverse side effects. In this case report we highlight Exogenous Lipoid Pneumonia (ELP), an uncommon condition that results from accumulation of exogenous lipids in the alveoli, as an adverse side effect of long-term Vicks VapoRub use.

What Is Pneumonia?



Case presentation

We present the case of an 85-year-old female patient with ELP apparently due to continuous application of Vicks VapoRub® to her nostrils to alleviate chronic rhinitis. She was diagnosed incidentally via chest radiograph and computed tomography (CT) scan done as follow up to finding elevated C-reactive Protein during a routine exam. The CT scan revealed a pulmonary consolidation in the lower lobe of the right lung with fat density combined with low density areas associated with focal ground-glass opacities. The patient was advised to discontinue use of petroleum-based products, and was prescribed intranasal corticosteroids for her rhinitis. Follow up 2 years later showed that the lipid consolidation had diminished in size by approximately 10 %.


Conclusion

Physicians must be aware that ELP can develop as a result of long-term application of petroleum-based oils and ointments to the nose and discourage such use of these products. Patients who have used petroleum-based products in this way should be screened for ELP. CT scan is the best imaging modality for establishing the diagnosis. The treatment of this condition is not well defined, but, as shown in this case, the size of the lipid mass can decrease after use of petroleum based substances is discontinued.


Electronic supplementary material

The online version of this article (doi:10.1186/s12901-016-0032-6) contains supplementary material, which is available to authorized users.


Keywords: Exogenous lipoid pneumonia, Rhinitis, Petroleum jelly, Case report

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Background

Exogenous lipoid pneumonia (ELP) is a rare condition resulting from the aspiration or inhalation of fat-like material of animal, vegetable or mineral origin [1]. The frequency of ELP is difficult to establish, but autopsy series have revealed frequencies of 1 to 2.5 % [2]. Forty four cases of ELP were identified in a nationwide retrospective study in France between 1981 and 1993 [3]. The principal factor for ELP is the inhalation of inert, long-chain, saturated hydrocarbons found in petroleum. Mineral oils and ointments can inhibit the cough reflex and ciliary motility, thus facilitating inhalation. Their presence in the pulmonary parenchyma causes a foreign body type of inflammatory reaction [4, 5]. Most ELP cases result from the use of oil-based laxatives for the treatment of constipation, or from nasal instillation of oily products, including petroleum ointment products such as Vaseline or Vicks VapoRub® [6], for relief of chronic rhinopharyngeal diseases. Reported sources also include lip balm/gloss [7]. Most of the patients who aspirate these substances are elderly people who have difficulty swallowing due to anatomic or functional issues, and who have a history of topical application or ingestion of lipid products [5].


Individuals with ELP can present with unspecified symptoms such as cough, dyspnoea, chest pain, haemoptysis or fever. They can also be asymptomatic, in which case ELP may be identified as an incidental abnormality on radiologic imaging [5, 8]. On physical examination findings are usually normal, although dullness on percussion, crackles, wheezes or rhonchus may be found [4]. Laboratory findings such as leucocytosis and increased erythrocyte sedimentation rate can be found, especially when complicated by an infection. In one study increased sedimentation rate was observed in 61 % of ELP cases [3]. Pulmonary function test results have shown a restrictive pattern in long-standing disease [4]. Prominent radiologic abnormalities have been found in the absence of symptoms or clinical signs in many ELP cases [9].


High-resolution computed tomography (CT) is the best imaging modality for establishing the diagnosis of ELP. The most frequent findings are airspace consolidations, ground-glass opacities, interlobular septal thickening, airspace nodules (small poorly-defined centrilobular nodules), and mass-like lesions [10]. The mass is typically irregular or spiculated as a result of chronic inflammation and secondary fibrosis. Since its clinical and radiological presentations are nonspecific, ELP may mimic many other diseases, including lung tumours [11]. The presence of fat in the mass is a diagnostic feature of ELP [12]. The radiologic manifestations of ELP can improve slowly over time, but typically remain stable even if exposure to oils or fats is discontinued. ELP-related fibrosis and destruction of normal lung architecture can result in cor-pulmonale [13].


Patients with rhinitis, a condition that usually presents with nasal congestion, rhinorrhea, sneezing and itching, often self-medicate, using over-the-counter decongestants or folk remedies [14, 15]. One traditional folk remedy consists of instilling medicated oil or ointment into the nose and sniffing it. A variety of oil-based products have been used, including pure sesame oil [12] and mentholated petroleum-based ointments such as Vicks VapoRub®.


Here we report the case of an patient in a routine medical visit with history of rhinitis and mentholated mineral ointment use who was found to have ELP.


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Case presentation

An 85-year-old Ecuadorian female self-referred for her annual routine visit to family physician (Additional file 1: Timeline Table). She had history of recurrent allergic rhinitis events with nocturnal runny nose since childhood. She revealed daily use of the over-the-counter mentholated mineral ointment decongestant Vicks VapoRub® for approximately 50 years to ease her discomfort. She applied this product to her chest, palms and feet, and aspirated it through her nose.


The patient had no signs or symptoms of respiratory disease at the time of the visit. Her physical examination was unremarkable. Her medical history included type 2 diabetes mellitus and hypertension.


Laboratory findings demonstrated an increased CRP (31.5 mg/L, reference value 0.0 – 5.0 mg/L). After obtaining no relevant results, a follow up chest radiograph was ordered. It showed airspace consolidation as an irregular mass-like-lesion in the right lower lobe. The patient continued to be asymptomatic despite the presence of this mass. A thoracic computed tomographic (TCT) scan of the chest was ordered. This showed a pulmonary consolidation of 5.0 × 4.5 cm in the posterior basal segment of the lower lobe of the right lung, containing negative density regions measuring between −130 HU and −61 HU, indicative of intrapulmonary lipid (Fig. 1). Focal ground-glass opacities were observed in the periphery and scattered ground glass opacities bilaterally, which are suggestive of pneumonitis. We recommended that the patient stop using Vicks VapoRub®, and prescribed intranasal corticosteroids for her rhinitis.


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Object name is 12901_2016_32_Fig1_HTML.jpg

Fig. 1

Thoracic CT at the first medical consultation

How to breathe if you have a respiratory infection like COVID-19



Twenty-six months after stopping daily mentholated ointment application a follow-up TCT and CRP was ordered. The pulmonary consolidation described above was still apparent, but the bilateral scattered ground glass opacities had diminished and the size of the mass had decreased by 0.5 cm in each dimension (4.5 × 4.0 cm) (Fig. 2). CRP was in reference value (2.03 mg/L)


An external file that holds a picture, illustration, etc.

Object name is 12901_2016_32_Fig2_HTML.jpg

Fig. 2

Thoracic CT 26 months after cessation of petroleum jelly


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Discussion

Although ELP is an unusual cause of chronic lung disease, it is an important consideration in the differential diagnosis of several pulmonary syndromes because progression appears to be halted, or at least slowed, by stopping exposure to the offending lipid substance. In our patient the presence of negative TCT density values in the mass implied the presence of lipid. That fact, together with follow up scan results, allowed us to rule out malignancy.


Several authors have suggested that negative density values between −150 and −30 HU in areas of consolidation are highly suggestive of intrapulmonary fat, and are consistent with ELP, especially when associated with a history of exposure to mineral oil or ointment. In order to prevent a false positive interpretation, measurements should be taken in the most hypodense part of the consolidation area, free of any aerated parenchyma on the periphery or areas of air bronchogram [5, 16, 17].


Systemic steroids have been used to slow the inflammatory response associated with ELP, but their use is supported only by few anecdotal reports [18–21]. Because inflammation will resolve spontaneously with cessation of exposure in most cases, it seems steroids can be withheld unless the lung injury is severe and progressive [8, 19].


ELP is often mild and does not appear to progress if use of the causative agent is stopped. However, there are few studies in which ELP masses are followed and measured after patients have stopped using oil-based substances. In one case involving a 38 year old woman with ELP, the mass was reported to have diminished 2 years after stopping oil ingestion, but the decrease was not quantified [22]. In the present case we measured the ELP mass at the time of diagnosis and 26 months after the patient discontinued use of mentholated petroleum ointment, and found a 10 % decrease in size. Prospective studies should be done to determine the average rate at which ELP masses decrease after use of the causative agent is stopped.


The best treatment for ELP is prevention. However, the fact that ELP is a potential risk associated with chronic use of lipid substances is not always appreciated, even by physicians. A recent review about rhinitis in geriatric populations said that use of oil substances in the nose is generally safe and can be used adjunctively with other treatment [23]. Mineral oil and ointment products are sold without prescription, and no information is provided for consumers or clinicians on possible hazards, especially among people at risk of aspiration, including the elderly and people with gastroesophageal reflux, dysphagia, nasal congestion or neurologic disease. Mentholated ointments have been shown to be cilio-toxic and mildly proinflammatory, increasing mucus secretion while decreasing mucus clearance [24]. This gives the sensation of increased airflow and therefore relief of symptoms, but in fact there is no improvement in airflow or decrease in nasal resistance with the use of these products [25].


Health professionals need to be aware of the risks and discourage the uncontrolled use of mineral oil and ointment, especially for the very young and the elderly [26].


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Conclusion

We suspect that our patient developed ELP due to excessive use of Vicks VapoRub® for chronic rhinitis. ELP was confirmed by TCT, which was ordered because of elevated CRP findings. Physicians need to be aware of this chronic adverse effect and discourage the use of mineral oil and ointment. The ability to recognize radiological manifestations of ELP can help establish an early diagnosis and start timely intervention.


The main intervention is discontinuing use of lipid substances. In the reported case, we found a 10 % decrease in size of the ELP mass 26 months after the patient stopped using Vicks VapoRub®. Further studies should be done to determine average rates at which ELP-related masses decrease after use of lipid substances is stopped.


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Acknowledgements

We appreciate the guidance and support of the MECOR Program, Sonia Buist, MD and Ana Menezes, MD. We are very grateful to Javier Delgado, MD, of Interhospital, for his help with image studies in the case. We also thank Mary Chaiken, PhD, for editing this manuscript.

Whenever we feel under the weather and have stuffy noses, a common home remedy we Singaporeans turn to is Vicks Vaporub gel.


Source


While most people apply the gel on our chest or temples, a handful of us tend to apply it directly under our nostrils to help us breathe better.


However, a recent Facebook post by a United States doctor named Dr Hawa Edriss warns us that doing so might be dangerous for our health.

Why is pneumonia so dangerous? - Eve Gaus and Vanessa Ruiz



Source


The post has since gone viral, garnering over 22,000 shares.


Man contracted pneumonia from breathing in Vicks Vaporub gel

According to Dr Edriss, a middle-aged man had been applying Vicks Vaporub gel directly under his nose for over 10 years to combat his persistent nasal congestion issue.


Since then, he went in and out of health care centres after being diagnosed with respiratory distress. Doctors determined his sickness to be infectious pneumonia, which is inaccurate, as Dr Edriss clarified in her post.


As we’ll find out, the disease is not infectious.


Upon picking up the case, Dr Edriss found that the accurate diagnosis for this man is Exogenous Lipoid Pneumonia.


Exogenous Lipoid Pneumonia caused by breathing in mineral oils

At this point, you must be thinking, what on earth is Exogenous Lipoid Pneumonia?


Exogenous Lipoid Pneumonia (ELP), as defined by Dr Edriss, is an uncommon pneumonia type caused by inhalation of fatty substance like animal fat, vegetable oil, or mineral oils.


Photo for illustration purposes only

Source


ELP can become apparent within 30 minutes of the inhalation on X-rays. The breather’s lungs will develop black spots within 24 hours of the last inhalation.


In this case, black spots can be seen in the man’s lungs as evidenced by his CT chest images below.


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Vick’s is not harmful if not applied directly under the nose

In conclusion, Vick’s Vaporub itself is harmless if not applied directly under the nose.


According to Dr Edriss, the gel contains tons of mineral oils like petrolatum, eucalyptus oil, cedarleaf oil, nutmeg oil, petrolatum, thymol and turpentine oil.


Inhaling oils directly will result in them getting stuck in the lungs like what happened to this man.


So if you’re feeling unwell, you can apply the gel on your chest, feet or temples. Just don’t apply it under your nostrils.


We have reached out to Vick’s Singapore for a statement and will update the article accordingly.


Know someone who has the habit of applying the gel under their nose? Share this piece of news with them in the comments below.

Can you recover from pneumonia at home?

Pneumonia is an inflammatory disorder of the lungs due to an infection of the airways. It is a serious condition, and home remedies will not treat or cure it.


However, certain home remedies may help ease the symptoms and enhance healing during the recovery period.


Pneumonia can be life threatening. Medical help is essential, and many people will need to spend time in the hospital. Afterward, it can take several weeks or months to recover.


Although medical treatment is essential, home remedies can help a person manage the symptoms and improve their comfort levels when they are not in the hospital.


Factors that increase the riskTrusted Source of pneumonia include:

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being under 5 or over 65 years of age

having exposure to tobacco smoke and air pollution

having asthma

having a weakened immune system

having other medical conditions, including COVID-19

In this article, learn more about the causes, symptoms, and home remedies associated with pneumonia and its effects.


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Causes and symptoms

A person with pneumonia should get plenty of rest and drink lots of fluids.

Pneumonia can occur for various reasons. For example, it often develops due to another illness or infection, such as chronic obstructive pulmonary disease, the flu, or COVID-19.


When a person’s immune system is healthy, their body can often prevent severe infections.


However, if bacteria, fungi, or viruses overwhelm the immune system, a more serious illness can result.


The most common symptoms of pneumonia include:


a cough

shortness of breath

chest pain

a fever

chills

fatigue and muscle aches

a headache due to a persistent cough

COVID-19 and pneumonia

The main symptoms of COVID-19 include a persistent dry cough and a fever.


If a person develops severe chest pain or difficulty breathing, a doctor will treat it as pneumonia.


The person may need to spend time in the hospital, using a respirator to help them breathe. Home remedies will not help in this case.


The Centers for Disease Control and Prevention (CDC)Trusted Source note that most people will experience mild symptoms and should stay at home until they feel better.


However, if a person more severe symptoms, such as difficulty breathing, it is essential to seek medical attention at once.


Home remedies for pneumonia symptoms

Depending on the cause of pneumonia, a doctor will prescribe medication to treat the infection.


During recovery, they will also recommend:


getting plenty of rest

eating nutritious foods

drinking lots of fluids

In addition, some home remedies may help a person manage the symptoms and enhance recovery. The following sections will discuss these in more detail.


Cough

If the lungs are producing extra mucus as part of an immune reaction, the body will use a cough to try to expel this fluid from the lungs. For this reason, a doctor may not recommend using a cough suppressant.


However, some natural methods may help reduce the severity of a cough, including:


1. Peppermint, eucalyptus, and fenugreek tea

Many warm herbal teas can help soothe a scratchy throat, but herbs may be more beneficial.


A 2011 study found that herbs, including peppermint and eucalyptus, had a soothing effect on the throats of people with upper respiratory tract infections. These herbs may help break up mucus and ease the pain and inflammation caused by pneumonia.

Pneumonia



A review from 2018 notes that fenugreek seeds might help break down mucus. A tea made from ground fenugreek seeds may therefore ease a persistent cough.


Eucalyptus and tea tree oils may also help relieve coughs. People can use these in a diffuser. However, they should try limiting their exposure at first, to ensure that the use of oils does not worsen their symptoms.


2. A saltwater gargle

Mucus in the throat and chest can trigger more coughing and irritation. A warm saltwater gargle may help eliminate mucus or germs in the throat, which may provide some relief.


Shortness of breath

Shortness of breath is a common symptom of respiratory infections. If a person has difficulty breathing, they need immediate medical attention.


However, if the symptoms are mild, the following tips may help:


3. Caffeine

Drinking a small amount of caffeine, such as a cup of coffee or black or green tea, may help open up the airways in the lungs. This could help a person breathe more easily.


4. Warm, damp air

Inhaling warm, damp air may ease breathing and keep the throat from tightening. Breathing in the steam from a shower or breathing over a warm cup of tea may help.


5. Rest

Rest is vital for cellular repair in the body, but it may be especially beneficial for shortness of breath. A person with pneumonia may benefit from keeping physical exertion to a minimum.


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Chest pain

Chest discomfort is a common symptom of pneumonia. The following remedies may help ease this symptom:


6. Ginger or turmeric tea

A persistent cough can result in chest pain. Drinking warm tea made with fresh ginger or turmeric root may help reduce this pain.


The roots of both of these plants can have a natural anti-inflammatory effect in the body.


Chop up a thumb sized piece of either root and boil it in a pint or so of water. If a person prefers strong tea, they can boil it for longer or add more of the root. If the flavor is too sharp, they can try adding a spoonful of honey.


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Fever

A person with pneumonia may also have a fever. As long as the fever is mild, a person may wish to use natural remedies to manage it.


If the fever is high or persistent, however, it is important to seek medical help. It could be a symptom of a severe infection.


The following remedies may help a mild fever:

Fighting the COVID-19 Pneumonia - (Prone) position yourself



7. Hydration

When a person has a fever, consuming liquids and electrolytes can help prevent dehydration. Drinking cool beverages or eating homemade ice popsicles may help hydrate the body and cool it down.


8. Fenugreek tea

As the 2018 review above notes, making tea from fenugreek seeds may encourage a person to sweat, which could reduce their temperature.


9. Over-the-counter pain relievers

Some over-the-counter drugs, such as ibuprofen (Advil), may help reduce fever and pain. It is important to take these medications with food and not exceed the recommended dosage.


10. A lukewarm bath or compress

Soaking the body in lukewarm water may help cool it down.


If it is not possible to take a bath, apply towels or washcloths to the body after dunking them in lukewarm water and wringing them out. This may help the body cool. When the towels warm up, dip them in the water again and reapply.


Chills

Chills are often a secondary symptom of a fever. The following home remedies may help ease chills:


11. Warm liquids

Drinking warm liquids may help warm the body up and prevent chills.


Some examples include:


warm water

herbal teas

a bowl of soup

Avoid sodas and consume either water or liquids that contain nutrients.


General symptoms

Some foods contain compounds may help boost the immune system, fight bacteria, and manage inflammation. These may help ease the symptoms of pneumonia more generally. For example:


12. Additional natural compounds

A number of at-home products contain compounds that may help boost the healing process. Examples include:


garlic

raw honey

cayenne pepper

tea tree oil

echinacea

It is worth noting that none of these substances or remedies will treat or cure pneumonia or any of the diseases linked to it, including COVID-19.


However, as long as the symptoms are mild or the person is recovering, they may help them feel better and contribute to their overall well-being.


When to see a doctor

Anyone who has difficulty breathing should seek medical help for diagnosis and treatment.


It is essential to follow any medical treatment plan that the doctor recommends and request additional help if the symptoms worsen or do not improve after a few days.

Pneumonia, Causes, Signs and Symptoms, Diagnosis and Treatment.



A doctor can also advise on some ways to prevent pneumonia from developing again.


Preventing pneumonia naturally

It is not always possible to prevent pneumonia, but some lifestyle choices can reduce the risk of developing it or experiencing severe symptoms.


These include:


adopting a varied and healthful diet

getting regular exercise

not smoking

avoiding air pollution, if possible

managing stress levels and getting enough sleep

practicing good hand-washing to reduce the risk of infection

following any instructions the doctor recommends for staying healthy

In the case of COVID-19, experts advise physical distancing from other people to prevent the spread of the virus.


Healthful lifestyle habits can help strengthen the body to fight off infections, including those that lead to pneumonia.


Summary

Pneumonia can be life threatening and usually needs medical treatment.


Many people will need to spend time in the hospital, and it can take months to recover fully.


During the recovery period, some home treatments may help a person feel better and encourage their body to heal.

Can your body cure pneumonia on its own?

Viral pneumonia is pneumonia that develops as a result of a viral infection in the lungs.


The symptoms of viral pneumonia are often similar to those of bacterial pneumonia, but, depending on the virus responsible, there may be a few additional symptoms.


A wide range of viruses can cause viral pneumonia, including influenza and coronaviruses, such as SARS-CoV-2, which causes COVID-19.


Viral pneumonia is often mild, but in rare cases, it can be life threatening.


Read on to learn more about the symptoms, causes, and treatment of viral pneumonia.


What are the symptoms?

The symptoms of viral pneumonia may include fever, shaking, chills, and fatigue.

The symptoms of viral pneumonia can range in severity and may include the following:


fever

a cough that is likely to be dry initially but may produce yellow or green mucus

shortness of breath

shaking

chills

muscle aches

fatigue

malaise

weakness

loss of appetite

blue tint to the lips

Some people with viral pneumonia may also have a sore throat or a headache, depending on the underlying cause of the infection.


Viral pneumonia tends to present differently in each age group.


Young children with viral pneumonia generally have mild symptoms that gradually worsen. A child with viral pneumonia may develop noticeable wheezing, and their skin and lips often take on a blue tint due to a lack of oxygen. They are also likely to lose their appetite.


On the other hand, adults over the age of 65 years may experience abnormally low body temperatures, confusion, and dizziness.


8 Signs Your Cough Could Actually Be Pneumonia | Health



Causes

A wide range of viruses can cause viral pneumonia, includingTrusted Source:


influenza A, B, and C viruses

coronaviruses, including those that cause COVID-19, Middle East respiratory syndrome (MERS), and severe acute respiratory syndrome (SARS)

parainfluenza virus

adenoviruses, which cause bronchitis and some common colds

varicella-zoster virus, which causes chickenpox and shingles

respiratory syncytial virus, which is most serious in young children but can cause cold-like symptoms in people of all ages

Viruses spread easily when affected people sneeze or cough. A person can also get the infection if they come into contact with a contaminated surface.


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COVID-19

Coronaviruses, a large family of viruses that cause respiratory illness, can lead to viral pneumonia. They include SARS-CoV-2, the virus that causes COVID-19.


The World Health Organization (WHO)Trusted Source declared the viral outbreak a pandemic on March 11, 2020.


According to the WHOTrusted Source, most reported cases are relatively mild — 81% of people have illness that causes no complications, while 14% will develop serious illness and need oxygen therapy, and 5% will need treatment in an intensive care unit.


Severe pneumonia is among the most common complications resulting from severe COVID-19. It may develop by the end of the first weekTrusted Source of infection.


People with preexisting health conditions and older adults are more likely to develop severe pneumonia from SARS-CoV-2.


The situation is still developing, so these findings and figures may change.


For live updates on the latest developments regarding the novel coronavirus and COVID-19, click here.


What are the risk factors?

Viral pneumonia can affect anyone, as the viruses that cause it are very contagious.


However, the following factors may increase a person’s risk of developing viral pneumonia:


being older than 65 or under 2 years of age

living in a group setting, such as a nursing home, prison, or dormitory

working in a hospital or nursing home

tobacco smoking

alcohol or illicit drug abuse

having a chronic illness, such as a heart, respiratory, or autoimmune disease

having a compromised immune system, possibly due to cancer or HIV

recovering from a recent viral infection

Viral pneumonia vs. bacterial pneumonia

Pneumonia is an infection in the lungs. Doctors classify pneumonia according to its cause. The usual causes of pneumonia include:


bacteria

viruses

fungal infections

Bacterial and viral pneumonia are more common than pneumonia resulting from fungal infections.


Bacteria such as Streptococcus pneumoniae cause bacterial pneumonia. This type of pneumonia is usually more severe than viral pneumonia.


The symptoms of bacterial pneumonia may include:

Causes of Pneumonia



very high fever

shaking chills, or rigors

rapid breathing

shortness of breath

a cough with blood or mucus

tiredness or lack of energy

Viral pneumonia may have some of the same symptoms, but the symptoms tend to be less severe.


Bacterial pneumonia requires treatment with antibiotics. Antibiotics do not help treat viral pneumonia unless there is a secondary bacterial cause.


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Diagnosis

A doctor will be able to diagnose viral pneumonia.


They will generally begin by asking about any symptoms and carrying out a physical examination. As part of the examination, the doctor will listen to the lungs for any abnormal sounds that may indicate pneumonia.


These sounds may include crackling in the lungs or wheezing while breathing. A doctor will also check for a rapid heart rate and decreased airflow.


If the doctor suspects that pneumonia may be present, they are likely to order some of the following tests to confirm the diagnosis:


chest X-ray

nasal swab to check for viruses

sputum culture of the mucus from the lungs

blood tests, including a complete blood count (CBC) to look for inflammatory markers

arterial blood gas test

The tests that the doctor decides to order will depend on the severity of a person’s symptoms and whether they are in one of the higher risk groups.


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When to see a doctor

People with a higher risk of developing pneumonia should see a doctor or visit an emergency room immediately if they develop flu-like symptoms alongside any of the following:


chest pain

a high fever

confusion in older adults

difficulty breathing or rapid breathing

Pneumonia can be extremely serious in higher risk individuals. These people will need immediate treatment for the best outcome.


What are the treatment options?

Viral pneumonia usually goes away on its own. Therefore, treatment focuses on easing some of the symptoms. A person with viral pneumonia should get sufficient rest and stay hydrated by drinking plenty of fluids.

Pneumonia – A Serious Condition to be Taken Seriously



A doctor may prescribe cough-relieving medication to help ease coughing. People should only take cough suppressant medicine if and when a doctor instructs them to because coughing helps clear the infection from the lungs. For those with thick lung mucus, a doctor may prescribe a cough expectorant.


In some cases of viral pneumonia, a doctor may prescribe antiviral medication to reduce viral activity. This treatment tends to be most effective when the virus is in the early stage of infection.


In rare instances, a doctor may hospitalize a person with viral pneumonia. People over the age of 65 or with chronic health conditions are more likely to need hospital care. The very young are also at higher risk for serious viral pneumonia.


Prevention

The viruses that cause viral pneumonia are contagious. During the cold and flu season, a person can take steps to stay healthy. These steps may protect against viral pneumonia and other viral illnesses.


Some techniques that people can use to try to prevent getting sick include:


washing the hands frequently with warm water and soap

getting a flu shot

avoiding touching the nose or mouth

getting enough sleep

exercising regularly

eating plenty of fresh fruits and vegetables

practicing physical distancing, including staying away from people who are sneezing and coughing

Takeaway

Most people with viral pneumonia recover within a few weeks. However, some people may take several weeks to recover fully, especially those who have a weakened immune system or are over the age of 65 years.


While viral pneumonia can be contagious, a person can practice good hygiene and self-care to lower their risk of getting the infection.

How do you sleep when you have pneumonia?

Shortness of breath can occur during activity, emotional excitement, exposure to adverse weather conditions, or when you feel tense and need to relax.

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In conjunction with pursed lip breathing and diaphragmatic breathing, use these breathing positions to help you reduce shortness of breath.


These positions are helpful when you have shortness of breath during activity, emotional excitement, exposure to adverse weather conditions or when you feel tense and need to relax.


Sitting

Rest your feet flat on the floor.

Lean your chest forward slightly.

Rest your elbows on your knees or rest your chin on your hands.

Relax your neck and shoulder muscles.



-OR-


Rest your feet flat on the floor.

Lean your chest forward slightly.

Rest your arms on a table.

Rest your head on your forearms or on some pillows.


Dr. Corry Avanceña talks about the symptoms and causes of pneumonia among children | Salamat Dok



Standing

Stand with your feet shoulder width apart.

Lean your hips against a wall.

Rest your hands on your thighs.

Relax your shoulders, leaning forward slightly and dangling your arms in front of you.



-OR-


Rest your elbows or hands on a piece on furniture, just below shoulder height.

Relax your neck, resting your head on your forearms.

Relax your shoulders.



Sleeping

Lie on your side with a pillow between your legs and your head elevated with pillows. Keep your back straight.


-OR-


Lie on your back with your head elevated and your knees bent, with a pillow under your knees.

How can I recover from pneumonia faster?

If you have pneumonia, the first priority is clearing the infection causing it.


This means following your doctor's treatment plan very closely. Yes, getting plenty of rest. And, yes, taking every single pill in the bottle of antibiotics your doctor prescribed you if your pneumonia is bacterial in nature.


But, even after your primary symptoms fade away, you may be left feeling lousy, with low energy and/or dealing with a cough that just won't quit. In some cases, you may feel weak for months.


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How long does it take to recover from pneumonia?

"Pneumonia is a serious illness that can take quite a toll on a person's lungs and body. It can take anywhere from a week to several months to fully recover from it," says Dr. Rayman Lee, pulmonologist at Houston Methodist.


The length of time it takes for you to recover from pneumonia is influenced by:


Your age

The severity of your illness

Whether you have other health conditions

The type of pneumonia


If you're generally healthy and have only a mild case of pneumonia, your symptoms should begin to improve one to two days after starting treatment.


"Most people with mild pneumonia are able to return to their everyday activities in a week, although fatigue and cough can linger for an entire month," says Dr. Lee.


Recovery timelines become more murky for people who have severe pneumonia.


"For more serious cases that require hospitalization, we're not only focused on clearing the infection, we're also focused on preventing or treating complications that can develop — including difficulty breathing, fluid buildup in the lungs, sepsis, acute respiratory distress syndrome (ARDS) and lung abscesses," warns Dr. Lee.


Pneumonia and its complications can wreak havoc on a person's lungs and body. And, it can take anywhere from one to six months for a person to recover and regain strength after being hospitalized for pneumonia.


Why does it take so long to recover from pneumonia?

You can't see the damage pneumonia causes, but you certainly feel it.

Treating Covid Pneumonia: Real Story told by a Frontline Doctor



The air sacs in your lungs become inflamed during pneumonia, leading to soreness and pain. If the infection and inflammation progress, your lungs may fill with fluid and dead lung tissue, leading to the green, yellow or even bloody mucus you cough up. This fluid may also affect how well oxygen is able to transfer into your bloodstream, leading to difficulty breathing.


"Once the infection is cleared with treatment, your body still has to deal with removing all of the fluid, damage and debris left behind in your lungs. This can take a few weeks, resulting in a lingering cough and reduced lung capacity," explains Dr. Lee. "During this time, you may find physical exertion more tiring than usual."


A more severe case of pneumonia can cause even more damage to your lungs, which can be significant and even permanent in some cases.


"After severe pneumonia, lung capacity is reduced and muscles may be weak from being so ill. Significant weight loss can further contribute to weakness and other health conditions may be aggravated due to the stress placed on the body during illness. These are all things your body will need time to recover from," says Dr. Lee.


In fact, it may take another several months for you to fully heal and regain strength.


"A person with pneumonia isn't discharged from the hospital until his or her infection is under control and vitals are stable, of course, but there's still a lot of work his or her body needs to do while recovering at home," says Dr. Lee.


How to regain your strength after pneumonia

While recovering from mild pneumonia, be sure to:


Get plenty of sleep

Eat a well-balanced diet

Slowly work back into your exercise routine


"Physical activity can help your lungs regain strength — but go slow. Start with light exercise and stop if your cough worsens or you have trouble breathing. If a light workout feels okay, you can put a little more effort into your next workout," says Dr. Lee.


However, Dr. Lee's advice for someone recovering from severe pneumonia looks quite different.


"The first thing to realize is that your body may be extremely weak after being discharged from the hospital, so you'll need to take extra care — leaning on your support network, if possible," says Dr. Lee.


Tips for regaining your strength after severe pneumonia

Get plenty of rest

Slowly start moving around once you're ready — but don't overdo it

Complete any (and all) treatments prescribed by your doctor

Eat a nutritious diet

Quit smoking and avoid second-hand smoke

Limit exposure to throat irritants, including pollution and alcohol

Perform deep breathing exercises

Consult with your doctor before returning to exercise


Aim to slowly work back into your usual routine (with guidance from your doctor) and be sure to take note of any signs that the infection may be coming back.


"Pneumonia can be incredibly taxing and there's no one-size-fits-all to recovery. Some people feel better in about six weeks, but it can take several months for others to feel better after severe pneumonia," adds Dr. Lee. "Most importantly, be patient with your body."


If your recovery is prolonged, a specialized program focused on pulmonary rehabilitation may help get you back on track.

Is Vicks bad for pneumonia?

Q. Long ago, I heard about using Vicks VapoRub at bedtime on the soles of the feet to calm a nighttime cough. Recently, my hubby developed a horrible deep cough that made him choke and gasp for breath. No cough suppressant he tried helped at all.

Pneumonia Overview | Causes, Symptoms, Diagnosis, and Treatment



Out of desperation, we dug out the Vicks, applied it to his soles, and he put on socks. In less than an hour, his cough completely subsided. It didn’t begin again until late morning the next day.


We followed this routine for 12 days until I finally convinced him to see a doctor. He was diagnosed with pneumonia. After 10 days of antibiotics and a week of prednisone, he is OK again. The doctor was surprised and maybe amused when I mentioned this home remedy.


A. We are impressed that Vicks VapoRub on the soles of the feet actually helped a serious cough that signaled pneumonia. We do NOT recommend toughing it out with a home remedy as long as your hubby did.


Q. I need your advice about lowering my blood pressure. I have found online advice conflicting and confusing. My family doctor, I’m sorry to say, is not interested in anything other than prescription drugs. While I’m sure they have their place in treatment, I want to exhaust natural remedies first.



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I am a 61-year-old male in very good health. My cholesterol and triglycerides are low to normal, but my blood pressure varies greatly. It has ranged from 142/86 to as high as 170/100. I average about 20 kilometers a week on the NordicTrack. Please help me figure out how to get my blood pressure under control.


A. Probiotics or yogurt with live cultures may be one helpful option. A meta-analysis of nine studies found that probiotics with multiple species of bacteria could lower blood pressure modestly (Hypertension online, July 21, 2014).

Pneumonia | Pathophysiology



Q. I have suffered from canker sores most of my life, and those on my tongue are very painful.


A few years ago, a reader got relief from acid reflux by eating jalapeños. I had avoided jalapeños all my life, but I gave them a try for heartburn.


The peppers work very well, but the biggest surprise was no more painful canker sores! Nothing else I’ve tried stops them. If I miss eating at least a couple of peppers a day for just a few days, the sores return.


But now, when one does occur, it is not very painful and heals quickly if I just get back to eating jalapeños each day.


A. Some readers have written about using aloe vera gel, baking soda or buttermilk on canker sores to help them heal faster. Others find that eating kiwi is an effective preventive measure. We’ve even heard that swishing sauerkraut juice around in the mouth a few times a day can help. But we have not heard before that jalapeño peppers have protective power against canker sores.

We report a case of exogenous lipoid pneumonia from chronic, extranasal use of petrolatum ointment (Vicks VapoRub in this case) for nasal decongestion in a young woman, presenting with cough, dyspnea and fever. Exogenous Lipoid pneumonia is a rare condition, underdiagnosed and is more prevalent in adults. Usually asymptomatic and diagnosed while evaluating predisposed patients who become clinically unstable or an abnormal lung shadow or during evaluation of rhinobronchial allergy. It is rarely reported from chronic use of petrolatum ointment extranasally and was diagnosed by transbronchial biopsy in the present case. She was found, retrospectively, to have been using petrolatum ointment, as an extranasal application since more than a year at bedtime. She didn't give history of using any other oil-based nasal topical vasoconstrictor preparations for sinusitis. Our patient was managed with discontinuation of further use of the petrolatum ointment and treatment with prednisolone apart from her regular treatment for chronic rhinobronchial allergy. Patient is stable without any further radiological deterioration during follow-up of one year.


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Keywords

Exogenous lipoid pneumoniaPetrolatum ointmentTransbronchial lung biopsyPrednisoloneTreatment

1. Introduction

Exogenous lipoid pneumonia (ELP) is an uncommon clinical condition, usually underdiagnosed in adults, and often results from either aspiration or inhalation of mineral or vegetable oils. Rarely, it was reported from chronic use of petroleum jelly, applied intranasally or extranasally as a decongestant. ELP was initially described by Laughlen in 1925 and can be either chronic from long term ingestion or inhalation of oily products or acute from accidental aspiration [1], [2]. The exact incidence was not known but reported as from 1 to 2.5% in an autopsy series [3]. In a retrospective study, it was noted in 34 patients (77%) from oil aspiration or inhalation and in 25% of the cases there is no discernible predisposing cause [2]. We report here a young patient suffering from chronic rhinobronchial allergy who was diagnosed as having ELP from chronic use of a petrolatum ointment, extranasally at bed time and successfully treated with prednisolone and discontinuance of usage of the same ointment. Previously reported cases were mostly from intranasal application of petroleum jelly and this case report emphasizes the fact that it can also be caused from the common practice of applying this product around the nose, externally [4].


2. Case report

23-year-old female, who was having history suggestive of chronic rhino bronchial allergy for the past five years, attended pulmonology outpatient with the complaint of cough, dyspnea and fever since more than four weeks. Vital signs were within normal range with SpO2 of 96%; her physical examination revealed bibasal lung crackles. Her past medical history revealed treatment with inhaled corticosteroids and fluticasone nasal spray on an irregular basis during exacerbations. She complains of recurrent headaches and underwent septoplasty with submucosal diathermy three years ago. Her routine blood work was within normal range with no peripheral eosinophilia and no sputum eosinophilia; her total serum IgE level was 731 ng/ml; her spirometry revealed mild restrictive ventilatory defect. Serum 25 hydroxy vitamin D3 was 9.12 ng/ml; chest radiograph showing bilateral infiltrates prompted for a computed tomography scan of chest (HRCT- Chest). The latter revealed multiple small well defined and ill-defined centrilobular nodules in both lungs, significantly in the left inferior lingula and in the basal segments of left lower lobe. The lesions show areas of tree-in-bud appearance and areas of confluence. Few small scattered centrilobular nodules were seen in the right lung in all the lobes (Fig. 1, Fig. 2).


Fig. 1

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Fig. 1. Axial HRCT section at the level of the lower chest reveals multiple tiny centrilobular nodules in the posterior basal segment of the left lower lobe and few nodules in the left lingula, right middle lobe and lateral basal segment of the right lower lobe.

Pneumonia Causes and Symptoms



Fig. 2

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Fig. 2. Sagittal HRCT section of the left lung reveals foci of ground glass haziness and tiny nodules in the lower lobe and inferior lingula.


Clinicoradiological opinion was either atypical pneumonia or to rule out tuberculosis. She underwent fiberoptic bronchoscopy for bronchial wash and transbronchial lung biopsy; bronchial washings sent for smear for acid fast bacilli and fungal elements were negative, with gram stain showing occasional polymorphs; geneXpert MTB/RIF was not detected; 20 ml of bronchial washings which was hemorrhagic revealed an occasional alveolar macrophage with many neutrophils with a background of blood elements. Trans bronchial lung biopsy (TBLB) revealed histological features suggestive of Lipoid Pneumonia (Fig. 3).


Fig. 3

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Fig. 3. H&E section (200×) showing lung tissue composed of alveolar spaces with flattened lining, a few spaces show desquamation of the lining epithelium. Alveolar spaces are filled with macrophages with vacuoles of varying sizes.


Meticulous history, retrospectively, revealed patient habituated to applying a petrolatum ointment to the nose, externally, daily at night since more than a year. She was treated with oral prednisolone, tapered over a period of six months, apart from her regular inhaled corticosteroid and Fluticasone nasal spray. Her follow up HRCT-Chest at the end of one year showed partial resolution of the previous lesions, and patient is clinically stable without any relevant symptoms. (Fig. 4).

Pneumonia Explained! Symptoms, Diagnosis, Labs, Treatment



Fig. 4

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Fig. 4. HRCT section at the level of the lower lobes reveals mild cylindrical bronchiectasis in the left lower lobe, faint tiny centrilobular nodules in the left lower lobe, right lower lobe and fibrotic lesions in the left lingula.


3. Discussion

Exogenous lipoid pneumonia is an uncommon entity without any pathognomonic clinical or radiological expressions. In adults, most of the cases emanate from usage of oil-based products as laxatives or for nasal application or instillations, especially for nasopharyngeal disorders. Medical literature contains many examples of exogenous lipoid pneumonia from intranasal instillation of petrolatum in the liquid form. A few case reports were found in the literature with examples of long-standing use of petroleum jellies applied intranasally [4], [5] and much rarer was external application causing ELP [6], [7], [8].


These reported cases were in patients who did not have underlying predisposing conditions for aspiration and mentholated topical ointments were used as nasal application for decongestant purpose, except for a case report of a female patient ingesting tablespoonful of cold Vaseline daily to induce soft daily bowel movement [9].


The predisposing factors are not obligatory for the mineral oil to penetrate the airways, as they were absent in 25% of cases [2]. It was noted that the petroleum jelly will liquefy at body temperature and lead to inhalation [5]. The oil finds its way into the alveoli of the lung, not only when directly introduced into the trachea but also at times when administered in sufficient quantities in the nose and throat [1]. The choice of liquid petrolatum as a “bland” vehicle for various medicaments used in the treatment of upper respiratory tract infections, is sufficiently light to enter the glottis without evoking the cough reflex. Then it is either aspirated or gravitates to the alveolar spaces [10]. Mineral oils can inhibit cough reflex and ciliary motility, thus facilitating inhalation [2]. Abanses JC et al. reported a case of an infant who presented with respiratory distress to the emergency after application of Vicks VapoRub directly under the nose. It was probably from the active ingredients of the aforementioned topical ointment which are noted to be ciliotoxic and mildly proinflammatory, thus increasing mucus secretion and decreasing mucus clearance [11].


The initial response of the oil in the alveoli, thus reached, is that of a foreign body reaction, from phagocytosis of emulsified oil by the alveolar macrophages. Thus, of the forty-four cases, the frequency of granulomatous form of inflammatory cell reaction was noted in 13 cases and the frequency of fibrotic lesions in 14 cases in the retrospective multicenter study by Gondouin A et al. [2]. Regardless of location, this inflammatory process can progress to fibrosis with destruction of alveoli and interstitium leading to chronic respiratory failure, end-stage lung disease and cor pulmonale [2], [12], [13].

Pneumonia: Types, Classification, Symptoms & Management – Respiratory Medicine | Lecturio



Usually the diagnosis is not suspected at the first instance since the presentations are not characteristic and simulate wide array of disorders of interstitium or alveolar consolidation or lung tumors.


Several imaging patterns are identified on CT but none of them are specific to chronic ELP.


CT imaging showing areas of fat attenuation between −150 and −30HU, reinforced by a ‘positive CT angiogram sign’, inside the pulmonary consolidative and nodular opacities is consistent with lipoid pneumonia. But, these imaging features are not always seen in ELP. Other manifestations of chronic ELP are single or multiple nodules or masses that may or may not contain fat. In the absence of recognition of fat attenuation in these lesions, it is difficult to differentiate from other diseases, especially, malignancy [12].


Spickard and Hirschmann suggest that a consistent clinical history and roentgenographic abnormalities must accompany, apart from the demonstration of the lipid laden macrophages in the alveoli or interstitium of the lung tissue, for the diagnosis of ELP [13].


In the present case, we initially thought of excluding an infective condition including atypical pneumonia or tuberculosis. We performed bronchoalveolar lavage (BAL) and TBLB consecutively for diagnostic confirmation.


Hence, Exogenous Lipoid pneumonia can only be diagnosed with a high index of suspicion and a detailed historical review in patients presenting with chronic rhinobronchial allergy and infiltrative lesions on chest radiographs. In case of a negative yield of BAL fluid for free lipids or lipids in the alveolar cell vacuoles, a TBLB would confirm the diagnosis, rarely requiring an open lung biopsy.


In our patient, after the diagnosis of ELP, systemic corticosteroids were instituted for her persistent dyspnea, fever and cough, with diffuse infiltrative lesions on chest radiography. Patient was clinically stable without further radiological deterioration during follow up for a year.


In the literature, we could find the only reference of Ayvazian LF et al. for the treatment of ELP with prednisone [9]. Brown AC et al. treated their patient of ELP with prednisone unsuccessfully, due to significant fibrosis [4]. Another report of Chin NK et al., was of Idiopathic lipoid pneumonia treated with prednisolone [14].

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4. Conclusion

Most of the therapeutic approaches available for the treatment of ELP, as of today, are from the experiences of the individual clinicians in the form of case reports.


Unsuspected causative agents, like Vicks VapoRub as in our case or any other agents containing mineral oils can silently or symptomatically lead to pulmonary fibrosis and even end-stage lung disease. Hence, high index of suspicion, early recognition, withdrawal of the offending agent and aggressive treatment of the underlying conditions like chronic rhinobronchial allergy, with a trial of oral corticosteroids, are the best therapeutic options available to date in the treatment of ELP, as in the present case.


Conflicts of interest

None.


Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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