Melanie Cole (Host): Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole and joining me today is Dr. Anirudh Rai. He's a primary care physician at Henry Mayo Newhall Primary Care. And he's here today to tell us about White Lung Syndrome, what it is, and should we be concerned?

Dr. Rai, it's always a pleasure to have you join us. What is white lung syndrome? I've never even heard of it. And why is the term white lung used for this?

Anirudh Rai, MD: Yeah, thanks for having me on board. Always nice to come on board and kind of have this conversation. So white lung syndrome, ideally has been more in the news because we see it especially overseas around China where they say there's the symptom, what we call a quote unquote white lung syndrome. But the best way to describe white lung syndrome is it's basically a description of an image finding. So it's not really an actual syndrome, it's more of a presentation you get.

And when you do an x-ray, you see essentially what they call a white lung. And the reason for this is, at least the way I was taught, was there's only three things that can appear on an x-ray on your lung. It's either blood, pus or fluid or water of any sort. So when you say white lung, generally, it's saying that during the x-ray, you see these patches or these presentations in the lung. And that could be for a multitude of reasons.

Host: Well, thank you for that, for explaining that it is more a description of an image that's taken of your lungs, because I think that that's really an important distinction. Is this pneumonia? Is this the same thing?

Anirudh Rai, MD: Yeah, that's a great question. Pneumonia is a topic in itself. And when you use the word pneumonia, we're talking about these infiltrates, whether it's going to be blood, fluid, or, water and, pus, essentially. So, pneumonia, in a sense, is these factors and these bacteria or viruses that can cause your lungs to essentially react in this way.

The best way to describe it is when your skin gets cut, you have a reaction, you have blood cells come in, it hurts a bit. Lungs have a similar response. In case anything foreign, whether a virus or bacteria or even anything like pollen, anything gets to a certain point in the lungs, there's cells that react to it, causing it to excrete these fluids into the lung in order to fight off these organisms, and because of that, we get these presentations of pneumonia, which is essentially lungs that are trying to fight off something that's there, whether it's bacteria, fluid, or any kind of foreign substance.

Host: So you mentioned China earlier. Is this something that we've heard about that's being seen there? Are you seeing it here? Do we know what's causing this?

Anirudh Rai, MD: The reason it got more of a news sort of presence is because it was primarily affecting, uh, the pediatric population, so our younger human beings, best way to describe it. And generally speaking, when COVID hit, kids weren't going to school, so there was this less transmission of these more common viruses and bacteria that we see these days.

As soon as schools opened up, people have more contact. These bacterias and these viruses that have not seen the normal presence in a normal environment, they tend to be a bit more virulent, meaning that they tend to have a more of a response that's a bit more exaggerated, best way to describe it. So normal viruses that do cause these, about three, four years ago would be just a normal sort of response your lung would have.

But the fact is, since these viruses have not had that exposure or this kind of transmission, their responses tend to be a bit more exaggerated and a bit more scary, best way to describe it. And essentially these organisms are some that we have seen in the past. So there's nothing new when it comes to new organisms. So these are just an exaggerated response of an old organism we are aware of.

Host: Well, I mean, that's good to know because we always get a little bit fearful if we hear there's something new cruising around. And certainly not what we need with all the respiratory viruses going around right now with flu and RSV, COVID and anything else that's going around. So signs and symptoms, how would we know? Because obviously there are these other things that are respiratory going around right now.

Anirudh Rai, MD: Yeah. Signs and symptoms tend to be something that everyone takes a hold of. A cough. People are very cautious when they get a cough. Generally speaking, when it comes to these pneumonias, particularly the ones caused by bacterias and even viruses, the coughs tend to be a bit more exaggerated. I mean, you'll have what we call a productive cough.

You tend to have certain sputum that comes out or mucus and it's pretty disgusting looking to the patient like this is really bad and they just throw it away. But that gives us an idea as a physician about what type of infection it may be, how we could treat it, and ideally accompanying all this would be fevers as well.

And fevers not of 100s but of like 101, 102. Generally, with bacteria, you tend to have a more exaggerated thermal response with the rest of the body with a higher temperature. I mean, the viruses, we tend to see temperatures around 100.4, 100.5, the more the low range of what we describe it. So, fevers, productive cough, just feeling tired. And having a hard time breathing can be some of the symptoms of pneumonia.

Host: Well, then what do we do? If we feel like this is the issue, nowadays, we've learned that we stay inside, we rest, we hydrate, we mask up if we have to go places so that we don't infect others. Is this something emergent? If we're obviously having trouble breathing, we're going to go to the emergency room or urgent care? When would that be something that you would recommend or to call our primary care provider?

Anirudh Rai, MD: Anytime there's a cough or is a concern that's coming to a patient, I say, definitely talk to your primary care doctor. Say, Hey, is there something I should worry about? Always having that looked at sooner can give us better chance of essentially avoiding the hospitalization if we can, or the emergency room.

So I would say if there's a cough that's bothering you, let us know. More often than not, these kind of coughs are common. Allergies are known to cause coughs. There's a lot of reasons for a cough. But if you're ever concerned about, Hey, I'm coughing up something. I feel tired. I have fevers. Definitely go to your primary care doctor. And worst comes to worst, if you can't breathe and have a hard time breathing, go straight to the emergency room.

Host: Dr. Rai, are you seeing this mostly in kids? Because you mentioned kids before. Are we seeing this like RSV? Are we seeing this mostly in children or also in adults?

Anirudh Rai, MD: RSV is more common in children prior to the pandemic. The reason I'm saying that is RSV, human metavirus, common cold rhinoviruses; these are very common in the children, pediatric population. And during the winter, we would see these viruses on the rise, essentially. But they would be in a manageable presentation, as in the kids tend to be presenting okay, they are having a little bit of a cough, might have some hard time breathing, but these are manageable symptoms.

Nowadays, since the RSV virus hasn't had time to kind of be mingling in the environment, because we were isolating ourselves and not being exposed to them again, these viruses had a more exaggerated response. Meaning they tend to be more damaging to the lung in that sense, and you'll have more of a cough.

And now we're seeing them actually affecting our older population, which is a bit odd. And for that, thankfully we have vaccinations, which tends to be, I would say, the best way to prevent these kind of viruses to have a lasting effect on the body. So the RSV vaccine thankfully came out and it's something encouraged in our older population to protect their lungs.

Host: Now we've talked a little bit about viruses and the white lung syndrome, but Dr. Rai, is this a bacteria? Is it a virus? And if so, then how is it treated? If somebody does suspect that they have white lung syndrome, if they have a pneumonia, if they have one of these respiratory illnesses; what are you doing for it?

Anirudh Rai, MD: Usually with white syndrome, they would be in a hospital setting. At that point, they would be treated with antibiotics. And very common organisms we see are something called strep pneumo, H influenza. These are very common organisms in our mouth, in that area, which tend to do no harm unless they go to an environment, which they've never been in before, which is in this case, the lung.

And when they're exposed in that environment, you'll have this exaggerated response. And when that happens, antibiotics are the treatment of choice for these pneumonias. Particularly for viral pneumonias, you tend to reach for antiviral medications. And even then, your body tends to have a really good response to viruses as well.

So, more often than not, people tend to recover from them. But it is rare in general to see a viral pneumonia. Very, very rare would be the fungal pneumonias for which we would treat using antifungal. So there is treatment for each one of these types of pneumonia. And when we do see it and we catch it, it is standard of care to treat it appropriately.

Host: You always are such a great guest, Dr. Rai. You're such a good teacher and educator and you explain things to us in a way that we can understand and take forward and give us preventive advice and advice how to treat ourselves and others. And this is just what a great podcast whenever you're on it.

I'd love for you to give us your best advice. Tell us what you would like us to know about white lung syndrome, pneumonia, RSV, all the respiratory things going around right now. And as the amazing primary care physician that you are, tell the listeners what you want us to take forward about this.

Anirudh Rai, MD: Absolutely. So white lung syndrome, even though it is a presentation of pneumonia, it is something treatable, is nothing new. It's nothing that we haven't seen before. And it is something we are definitely on the lookout for. The best way to prevent these kind of pneumonia, especially ones caused by viruses, get vaccinated from RSV, get vaccinated for the flu, follow up with your doctor when you can if you have any concerning symptoms, and honestly just be cautious and practice good hygiene.

That would be the best way to monitor yourself for pneumonia in general, and it is something we are always going to keep an eye on as physicians. See your doctor when you can.

Host: Thank you so much, Dr. Rai. What great information today, and contact your pediatrician if your child shows symptoms of white lung syndrome. And if you're 17 or older, you can call Henry Mayo Primary Care at 661-200-1710 or visit henrymayoprimarycare.com. You can also visit the free health information library at library.henrymayo.com because there is so much information there that you can trust, quality information. So it's a great place to go when you're looking for that kind of information, because we never know what we can trust, but that's what you can trust. Thank you so much for joining us today. And that concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital.

Please remember to subscribe, rate, and review this and all of our podcasts. I'm Melanie Cole. Thanks so much for joining us.