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Jul18
HOMEOPATHY CURES ASTHMA COMPLETELY
Asthma is a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Common symptoms include wheezing, coughing, chest tightness, and shortness of breath.
Bronchial asthma is an inflammatory disease of the respiratory airways. People who have asthma are usually allergic to a combination of substances, such as pollen. When exposed to these substances, they begin to experiencing wheezing, difficulty breathing, chest discomfort and episodes of coughing. If treated properly, asthma rarely causes long-term complications, but if left untreated the disease can cause a variety of complications.

Asthma can occur at any age. But the Child hood asthma or children asthma is the most common health problem in the present day society. Similarly chronic bronchitis is also another major respiratory problem frequently occurs in children at any age groups. If this chronic bronchitis is not treated properly with constitutional homeopathic treatment then it may turns into bronchial asthma in the future. The common symptoms of chronic bronchitis and child asthma are - frequent attack of cough, cold, fever, tightness of chest, shortness of breath with wheezing sound on respiration, easy fatigue and loss of appetite. The prevalence of asthma is increasing especially in the children. That episodic attack of child asthma and chronic bronchitis can be cured completely and permanently by constitutional homeopathy treatment.

The chronic bronchitis and bronchial asthma are not only limited to children but in adult case also. But in comparison to adult the children are more suffer with chronic bronchitis and asthma because children are exposed to more and more allergens such as dust, air pollution, and second-hand smoke. Their immune system is not so much stronger to resist those infections. Another factor is decreasing rate of breastfeeding to the children that deprives the essential substances required for a healthy immune system of a child. So it is also another major factor of weak immune system of the child. Now a day the children more like to all types of junk and fast foods that also one factor of deprivation of essential micro nutrients needed to build up a healthy immune system. The others causes are the genetic or hereditary factors.
CAUSES OF CHRONIC BRONCHITIS AND ASTHMA
The external environmental factors: Those are - exposure to dusts and pollen, secondhand smoke, faulty diet habits, food allergens, chemicals (pesticides), environmental factors (dust mites, cats, cockroaches, fungi) and temperature intolerance are major factors of creating chronic bronchitis and asthma. Physical exertion or exercise also influences to induce asthmatic episode. Certain infections such as viral, bacterial, or fungal infections often lead to asthmatic breathing too.

The Internal Immunological or hereditary factors: Besides the external stimulatory factors, the low immune system of the child also plays an important role in manifesting the symptoms asthma and bronchitis in child cases. There are many factors responsible for weak immunity of a child. Among them decreasing rate of breast feeding that deprives the required essential substances for a healthier immune system, habits of taking more junk and processed foods that also deprives the essential micronutrients required to build up a healthy immune system plays the most important role in developing chronic bronchitis and asthma. Thus the weak immune system of the child is very prone or susceptible to any change in the atmosphere or slightest exposure to any infection may be viral or bacterial or fungi lead to develop respiratory problems.
CHANGES OCCUR IN THE RESPIRATORY TUBES OF AN ASTHMATIC CHILD
Asthma is a respiratory disorder caused by the inflammation in the airways called the bronchi that lead to the lungs. This inflammation can constrict the airways and tighten, which blocks air from flowing freely into the lungs, making it hard to breathe. Symptoms include wheezing, shortness of breath, tightness of chest, and fatigue on little exertion or play, shortness of breath and cough at night or after exercise/activity. The inflammation of the bronchus makes them very sensitive, resulting in spasm of the airways that tend to narrow, particularly when the lungs are exposed to any allergens, cold air, any smoke, infection and exercise. Things that trigger asthma differ from person to person. Some common triggers are allergies, viral infections, exercise, and smoke. When asthma patient is exposed to a trigger, their bronchus become inflamed, swell up, and fill with mucus. In addition, the muscles lining the swollen bronchus tighten and constrict, making them even more narrowed and obstructed. The inflammation of the bronchus, excess mucus secretion, narrowed airways or bronchoconstriction are the three major changes that occurs in asthmatic bronchus. Anyone can have asthma, including infants and adolescents. The recent scientific reports suggest that patients with asthma are likely to develop more severe problems due to H1N1 infection.

Thus for a permanent cure to chronic bronchitis and child asthma conditions, the treatment should be aimed to build up a healthy immune system. If the immune system is healthy and strong enough that can be able to protect the child from various allergens and infection that are suppose to give bad impact in their body. It can only be possible by the constitutional homeopathy treatment.

How you can know your child has bronchitis or asthma

Runny nose
Frequent coughing generally occurs at night, while playing or laughing. In early stage cough is the only symptoms present
Malaise (feverishness)
Sometimes sore throat and headache with body pain
Less energy during play
Rapid breathing and complain of chest tightening
Cannot sleep at night with difficult breathing and cough
Whistling sound (wheezing) when breathing in or out
Feeling of weakness and tiredness
No appetite
Please note that all the symptoms mentioned above are not similar to all child it can vary from child to child. The symptoms are also not same in every time the child get the bronchitis and asthma episodic attack. Some symptoms may not come.

PATHOPHYSIOLOGY
When we inhale the air it goes through the nose then through the air tube called trachea that bifurcates into two tubes called left bronchus and right bronchus which supply to the respective left and right lungs. Each bronchus then branches to number of small tubules called bronchioles. Each bronchiole end with a terminal sac like structure called alveoli. It is elastic in nature. The alveoli is surrounded and covered with network of blood vessels. When we breathe in the air with oxygen entered into the bronchus then to the bronchioles then to alveoli. The oxygen is transferred to the blood at the alveolar portion through the network of blood vessels and simultaneously carbon dioxide is received from the blood to the alveolus and is expelled out when we breathe out. This ingoing and out coming of air through the bronchioles and bronchus occurs in a smooth and rhythmical way when the bronchial tubes are free and clear. If there will be any constriction of bronchial tubules due to inflammation of inner bronchial layer, the spasm of bronchial tubules occurs that obstruct the smooth passage of air and the person will face difficulties taking the air in or leaving out. This is the condition called asthmatic condition. Due to the passing of air in a constricted tubules the whistling sound comes which is called in ronchi.
DIFFERENCE BETWEEN BRONCHITIS AND ASTHMA
Asthma is a condition where the bronchial tubes go into spasms. When this happens there is coughing, tightness of chest and has difficulty breathing, and wheezing can often by heard as air attempts to get through the narrowed bronchi. There is often no mucus. Bronchitis is inflammation of the bronchi. The patient with bronchitis always has a cough, dry in the early stage and with of sputum in the later stage. There is no tightness or constriction feeling on chest. It can be due to smoking, or any number of illnesses like colds, or flu.
COMPLICATION OF BRONCHITIS:
1. Patients suffering from bronchial asthma often develop a decreased ability to exercise or perform other physical activities

2. Bronchial asthma can cause a permanent change in the respiratory pathways. This process is called airway remodeling, and is a complication of untreated asthma. The constant inflammation causes the airways, or bronchi, to narrow. This adversely affects the patient's breathing efficiency. If asthma causes airway remodeling, then the patient will need to be monitored for difficulty breathing and decreased oxygen content of the blood.

3. Severe, chronic cases of bronchial asthma commonly prevent patients from getting adequate amounts of sleep. This is because the disease often manifests at night, which causes patients to wake up; the hormones that cause the inflammation of the airways can be released even when patients are asleep. This causes patients to wake up wheezing, coughing or breathing heavily.

HOMEOPATHIC MANAGEMENT:
There are two main variations of the classical approach of homeopathy treatment. One approach applies homeopathic remedies to disease classifications or pathology. This is the so-called clinical approach. The second variation is purely symptom similarity from totality of symptoms i.e. constitutional approach. Current research indicates that the constitutional and clinical approaches are about equally effective and are the preferred classical methods. Genetic Homoeopathy applies both the clinical and constitutional approach of homeopathy treatment.


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May07
WORLD ASTHMA DAY
हर वर्ष मई माह के प्रथम मंगलवार को विश्व अस्थमा दिवस होता है. इस वर्ष ६ मई को विश्व अस्थमा दिवस मनाया गया , तो मित्रों सोचा की आज इस व्याधि और इसकी चिकित्सा के बारे में कुछ जानकारी आपके साथ बांटी जाए.

भारत में एक कहावत प्रचलित है कि दमा दम के साथ ही जाता है।

अस्थमा या श्वास रोग मनुष्य में उपस्थित श्वासपथ की एक बीमारी है. मानव शरीर सभी बाहरी पदार्थों को स्वीकार नहीं करता. जिन पदार्थों को वह अस्वीकार कर देता है उन्हें एलर्जेन कहते हैं . उन एलर्जेन के संपर्क में आने पर प्रतिरोध करते हुए शरीर में जो अलग अलग लक्षण प्रकट होते हैं उन्हें एलर्जी कहते हैं। हमारी श्वास प्रणाली जब किन्हीं एलर्जेंस के प्रति एलर्जी प्रकट करती है तो वह श्वास रोग, दमा या अस्थमा कहा जाता हैं। यह दीर्घकालिक रोग होता है । अस्थमा के रोगी को सांस फूलने या साँस न आने के दौरे बार-बार पड़ते हैं और उन दौरों के बीच में वह अकसर सामान्य रहता है।

हाल ही में हुए आंकड़ों से पता चलता है कि पूरी दुनिया में २३५-३०० मिलियन लोग अस्थमा से पीड़ित हैं , और लगभग २,७0,000 लोग हर साल इस रोग से मरते हैं। लड़कों में मृत्यु दर लड़कियों की तुलना में दुगनी , वयस्क महिलाओं में पुरुषों की अपेक्षा व युवाओं में बुजुर्गों की अपेक्षा अस्थमा अधिक होता है.


अस्थमा के कारण - एलर्जी
• पशूओं की त्वचा, बाल, या रोयें से
• घास व पौधों के पराग व धूल के कणों से
• सिगरेट के धुएं व वायु प्रदूषण से
• ठंडी हवा या मौसमी बदलाव से
• पेंट की गंध, परफ्यूम या रूम फ्रेशनर से
• भावनात्मक मनोभाव (जैसे रोना या लगातार हंसना) और तनाव से
• वंशानुगत लक्षण
• गर्भावस्था में यदि महिला तंबाकू के धुएं के बीच में रहती है, तो उसके बच्चे को अस्थमा हो सकता है

लक्षण

• छींक या खांसी आती है ,नाक बजती है व सांस फूलती है; रात और सुबह में सांस लेने में तकलीफ बढ़ जाती है
• अचानक शुरू होता है व थोड़े थोड़े गैप के साथ आता है
• व्यायाम करने से या ठंडी जगहों पर तीव्र होता है
• दवाओं के उपयोग से ठीक होता है
• खांसी; बलगम के साथ या बगैर होती है
• सांस लेते समय घरघराहट या सीटी जैसी आवाज़ आती है
• पीड़ित लोग कहते हैं की वे सांस पकड़ नहीं सकते

ऐसा करें
• धूल से बचें
• पालतू जानवरों को हर २ या ३ दिन पर नहलाएं.
• अस्थमा से प्रभावित बच्चों को उनकी उम्र वाले बच्चों के साथ सामान्य गतिविधियों में भाग लेने दें |
• स्टफड खिलोंनों को हर हफ्ते धोंए वह भी अच्छी क्वालिटीवाल एलर्जक को घटाने वाले डिटर्जेंट के साथ
• सख्त सतह वाले कारपेट अपनाए |
• एलर्जी की जांच कराएं जिससे आप एलर्जन की पहचान कर सकें |
• दवाइयों के असर न करने पर चिकित्सक से परामर्श करें

ऐसा न करें
• यदि आपके घर में पालतू जानवर है तो उसे अपने विस्तर पर या बेडरूम में न आने दें |
• गार्डन या पत्तियों के पास में ज्यादा काम न करें और न ही खेलें |
• दोपहर में परागकणों की संख्या बढ जाती है .उस समय बाहर काम न करें
पंख वाले तकिए का इस्तेमाल न करें |
• घर में या अस्थमा से प्रभावित लोगों के आस -पास धूम्रपान न करें
• अस्थमा से प्रभावित व्यक्ति से सामान्य व्यवहार करें |
• अस्थमा का अटैक आने पर न घबराएं. इससे प्रॉब्लम और बढ जाती है

चिकित्सा
मेरे पास ऐसे अनेक रोगी आते हैं जिन्हें वर्षों से ऎसी बीमारी है ; और इलाज में बहुत पैसा लग चुका है. अस्थमा / दमा के गरीब मरीजों को और जनसामान्य के हित के लिए इसकी प्रारंभिक चिकित्सा बतायी जा रही है. आपको सलाह दी जाती है कि यदि आप पैसा खर्च करने में समर्थ नहीं हैं तो यह उपचार करें. परन्तु इनसे भी आराम न मिले तो आयुष चिकित्सक से मिलकर उनके परामर्श द्वारा इसकी चिकित्सा करें.

अदरक की गरम चाय बनाएँ . इसमें लहसुन की ४ कलियां पीसकर मिलाएं . सबेरे और शाम इस चाय का सेवन करने से श्वास रोग नियंत्रित रहता है
५-६ लौंग लें और १५० मिली पानी में १० मिनट तक उबालें। इसे थोडा ठंडा करके इसमें एक चम्मच शुद्ध शहद मिलाएँ और दिन में २-३ बार पिलायें
३०-३५ मिली दूध में लहसुन की ५-६ कलियां डालकर उबालें और इस मिश्रण का हर रोज सेवन करें. इससे अस्थमा की प्रारंभिक अवस्था में लाभ होता है
२५० मिली पानी में मुट्ठीभर सहजन की पत्तियां मिलाकर करीब १० मिनट तक उबालें। मिश्रण को ठंडा करके इसमें एक नमक, चौथाई सैन्धव लवण,चुटकी भर कालीमिर्च और एक नीबू का रस मिलायें .इस सूप का नियमित रूप से इस्तेमाल करें
हरिद्रा खंड ५ ग्राम नियमित रूप से प्रातः सांय गरम दूध के साथ सेवन करें. ये एंटी एल्लेर्जिक की तरह कार्य करता है साथ में ही लवंगादि वटी को चूसते रहे .
यदि परेशानी बढ़े तो किसी अच्छे चिकित्सक से परामर्श करें
इनहेलर्स का प्रयोग दमा रोग में श्वसन तंत्र की सूजन को कम करने के लिए किया जाता है. इससे रोगी को तुरंत आराम मिलता है.
इस रोग को नियंत्रित करने के लिए इसके कारणों के विपरीत आचरण करें - धूम्रपान न करें, ठंड से तथा ठंडे पेय लेने से बचें, बहुत अधिक श्रम न करें।
दमा के रोगी को नियमित व्यायाम, पौष्टिक आहार, खुली हवा में लंबी-लंबी साँसें लेनी चाहिए
सीधे बैठें और आराम से रहें; तुरंत सुनिश्चित मात्रा में रिलीवर दवा लें
पांच मिनट के लिए रुकें, फिर भी कोई सुधार न हो तो दोबारा उतनी दवा लें।

अस्थमा से जुड़े धारणा और तथ्य
धारणा : दमा का पूरी तरह इलाज बहुत जल्दी ही सम्भव है।
तथ्य: यह लम्बे समय तक रहने वाली बीमारी है। पूरी तरह से कुछ ही दिनों में इसका ठीक होना संभव नहीं है

धारणा : अस्थमा एक हार्मोनल बीमारी है।
तथ्य: यह कोई हार्मोनल बीमारी नहीं है।

धारणा : दमा के मरीज़ स्पोर्टस में भाग नहीं ले सकते।
तथ्य: स्पोर्टस में भाग लेने से अस्थमा की स्थिति ना ठीक होगी और ना ही बिगड़ेगी।

धारणा : अस्थमा की दवाओं में स्टेरायड होने की वजह से वो सुरक्षित नहीं होतीं।
तथ्य: अस्थमा की दवाओं में स्टेरायड की बहुत कम मात्रा होती है। यह मात्र नुकसानदायक नहीं होती

धारणा : लम्बे समय तक अस्थमा की दवाएं लेने पर बीमार होने पर अन्य दवाओं का असर नहीं होता
तथ्य: यह आवश्यक नहीं है अलग-अलग दवाओं का प्रभाव अलग होता है।

धारणा : अगर मैं अच्छा महसूस करता हूं तो इसका अर्थ है कि मेरा अस्थमा ठीक हो गया है।
तथ्य: अगर अस्थमा के लक्षण नहीं पता लग रहे तो इसका मतलब यह नहीं कि अस्थमा ठीक हो गया है।

धारणा : बच्चों को अस्थमा की दवा देने का सबसे अच्छा तरीका है नेबुलाइज़र।
तथ्य: यह गलत है, आज नेबुलाइज़र की जगह स्पेसर मास्क का प्रयोग किया जा रहा है जो उतने ही प्रभावी है।

इनका सेवन करें :-
फल व सब्ज़ियां खाएं. इनमें बीटा कैरोटिन व एण्टीआक्सिडेंट बहुत अधिक होता है
साइट्रस फूड जैसे संतरे का जूस, मुसम्मी इनमे विटामिन सी होता है
हरी सब्जियों में विटामिन ए होता है .ये अलर्जी के प्रतिरोध में सहायक होते हैं
दाल और हरी सब्ज़ियां खाएं. इनमें विटामिन बी की मात्रा ज़्यादा होती है , वो अस्थमैटिक्स को अटैक से बचाती हैं।
कच्चे प्याज़ का प्रयोग करें .इसमें सल्फर की मात्रा बहुत ज़्यादा होती है जिससे आस्थमा में लाभ मिलता है।
पालक , फाईबर युक्त भोजन का उपयोग करें .
यदि मांसाहार करते हैं तो भोजन में सी फूड, चिकेन और मीट ले सकते हैं; इनमें सेलेनियम होता है।
ओमेगा 3 फैटी एसिड फेफड़ों में हुई सूजन को कम करता है. ओमेगा 3 फैटी एसिड मछलियों, सैल्मन, ट्यूना और कॉड लिवर में पाया जाता है।
हलिबेट, ओएस्टर भी ले सकते हैं जिसमे मैग्नीशियम होता है जो कि श्वास नली से अतिरिक्त हवा को अन्दर आने देते हैं.

इनका सेवन न करें
•शीतल खाद्य पदार्थो व शीतल पेय

•उष्ण मिर्च-मसाले व अम्लीय रस से बने खाद्य पदार्थ

•भोजन में अरबी, कचालू, रतालू, फूलगोभी, केले, उड़द की दाल, दही और चावल. ऐसा आयुर्वेद चिकित्सा सिद्धांतों में माना जाता है.


तो मित्रों अगर आप की जानकारी में भी कोई अस्थमा रोग से पीडित है तो विश्व अस्थमा दिवस पर
उसे यह जानकारी देकर एक जिम्मेदार नागरिक होने का कर्तव्य निभाएं.
जनहित में ये जानकारी शेयर करें .

“सर्वे भवन्तु सुखिनः सर्वे सन्तु निरामयाः ।
सर्वे भद्राणि पश्यन्तु मा कश्चिद्दुःखभाग्भवेत् ॥“


शेष अगली पोस्ट में.....
प्रतिक्रियाओं की प्रतीक्षा में,

आपका अपना,
डॉ.स्वास्तिक
चिकित्सा अधिकारी
( आयुष विभाग , उत्तराखंड शासन )

(निःशुल्क चिकित्सा परामर्श, जन स्वास्थ्य के लिए सुझावों तथा अन्य मुद्दों के लिए लेखक से drswastikjain@hotmail.com पर संपर्क किया जा सकता है )


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Mar28
AYURVEDIC MEDICINE AMRITADI KWATHA ALONG WITH PRANAYAMA FOUND USEFUL IN THE MANAGEMENT OF BRONCHIAL ASTHMA
Modern medicine is rapidly developing medications that provide instant relief from symptoms, but the hazards of beta agonists and complications of corticosteroids prompt the search for alternative modalities in the management of bronchial asthma.

The present research study evaluated easily available, inexpensive and non-controversial herbal drugs as well as

Pranayama in the management of bronchial asthma.
For this clinical study 60 patients have been divided into 3 groups. 1st Group was treated with trial drug and 2nd Group with standard drug. The 3rd Group was treated with trial drug and Pranayama. All the groups have equal number of patients -i.e. 20 each.

The short-listed patients were diagnosed on the basis of a detailed questionnaire including the history, clinical examination as well as laboratory investigations. The diagnosis was further confirmed using spirometer.

Diagnosis has been made according to bronchial reversibility test i.e. 15% increase in FEV1 after 15 minutes of two puffs of a adrenergic agonist. Subjective as well as objective parameters were adopted for assessing the response of trial drugs graded in to 0, 1, 2, and 3. Patients were advised to practice the anulom vilom pranayama BD, 10m.

After the study results were analysed and Group I & III showed significant improvement in clinical symptoms whereas Group III patients also showed marked improvement in PULMONARY FUNCTION TESTS (FEV1, FVC, PEFR).

It was observed that anulom vilom pranayama has a definite additive effect with standard drug therapy in the treatment of Tamak swasa (bronchial asthma) as shown by the subjective and objective assessment.

This research study was conducted by researchers of A & U Tibbia College, Karol Bagh, N. Delhi, India

(ये सूचना आयुर्वेद विज्ञान के बारे में आपके ज्ञान वर्धन व इसके वैज्ञानिक दृष्टिकोण को समझाने हेतु है.
किसी भी रोग से पीड़ित होने पर अपने चिकित्सक के परामर्श अथवा मुझसे drswastikjain@hotmail.com पर संपर्क करने के बाद ही कोई दवा लें.)


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Mar21
AYURVEDIC DRUG SHWAS KASA CHINTAMANI RASA PROVED TO BE USEFUL IN ASTHMA
Asthma is the most common chronic childhood disease in nearly all industrialised countries. An attack is experienced when the asthmatic child's chronically inflamed bronchial airways, having become sensitised to certain environmental allergens (e.g., dust, smoke) and conditions (e.g., exercise, cold weather, stressful emotions), begin to overproduce mucus in their presence.

This leads to the swelling and muscle contraction that obstructs air flow and restricts breathing. Although asthma has been known for millennia, but even after century a root cure of asthma is not yet available. The modern medicines of asthma can control the acute asthma symptoms, but did not cure this disease significantly.

In a recent research study conducted in Banaras Hindu University Varanasi; The children with age group of 2-12 years having symptoms of cough, fever, breathlessness, running nose, restlessness, wheezing, etc., were selected and divided into subgroup 'A' having positive history of taking bronchodilator and corticosteroid and subgroup 'B' having positive history of taking bronchodilator only whereas subgroup 'C' patients having no history of taking steroid or bronchodilator prior to the registration.

Patients were advised to take SKCR drug in a dose of 4 mg/kg/dose × 12 hrly (in powdered form) mixed in Garlic: Ginger: Honey (GGH) [in 1:2:4 ratio] to the patient and given for the 45 days.

The drug SKCR was given for a total of 45 days in a dose of 12 hourly with garlic, ginger and honey in ratio of 1:2:4. In most of the cases findings were suggestive of significant clinical improvement during the follow-ups.

In present study, analysis of incidence of common features in group 'A' all the signs and symptoms were subsided except the cough and wheeze in one case (10%) on third follow-up while on second follow-up approximately 40% cases relapsed after getting fresh exposure to the trigger factors during the management. In group 'B' and group 'C', incidence of most common features were subsided and all the patients had became asymptomatic on third follow-up.

This study suggested that the drug
SHWAS KASA CHINTAMANI RASA IS MORE EFFECTIVE IN THOSE CASES WHO ARE NOT RECEIVING CORTICOSTEROID WITH BRONCHODILATOR IN COMPARISON TO CHILDREN RECEIVING CORTICOSTEROIDS WITH/WITHOUT BRONCHODILATOR.

IT IS ALSO EFFECTIVE IN CHILDHOOD BRONCHIAL ASTHMA THAT HAS THE HISTORY OF STEROID AND BRONCHODILATORS. NO SPECIFIC ADVERSE EFFECT OF DRUG SKCR WAS OBSERVED.

(This research was conducted by researchers of Department of Kaumarbhritya, Faculty of Ayurveda, Banaras Hindu University, Varanasi,)

(ये सूचना आयुर्वेद विज्ञान के बारे में आपके ज्ञान वर्धन व इसके वैज्ञानिक दृष्टिकोण को समझाने हेतु है. किसी भी रोग से पीड़ित होने पर चिकित्सक के परामर्श से ही कोई दवा लें.)


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Jun02
POST OPERATIVE ATELECTASIS IN THE ELDERLY
Atelectasis is the most common post operative pulmonary complication by which tissue oxygenation may be compromised in the elderly. It affects a quarter of all patients recovering from abdominal or thoracic surgeries. . Atelectesis, a failure of part of the lungs to expand, usually develops during the first or second postoperative day. Contributing factors in the aged are shallow breathing, obstruction of the airway with secretions, pain (which results in smaller tidal volumes), immobility, a transient decrease in surfactant production, a weakened cough reflex and decreased ciliary movement. Atelectasis as a result of any of these factors can lead to a mismatching of ventilation and perfusion and thereby, to arterial hypoxemia.
Areas of alveolar collapse or atelectasis are prone to infection. if an area of the lung remains atelectatic for greater than 72 hours, pneumonia is likely to develop. In the elderly, taking agressive measures to prevent atelectasis is preferable to treating pneumonia that may result from it. Frequent incentive spirometry maneuvers with an inspiratory hold, turning every two hourly, early ambulation and mobilization as soon as the vitals are stable, are important therapeutic interventions. Pain management without the use of sedatives, that depresses respirations, can also prevent alveolar compromise.
If atelectasis does develop, strategies such as administration of chest physiotherapy for mobilizing secretion, hyperinflation therapies such as IPPB ( Intermittent positive pressure breathing) or CPAP ( Continuous positive airway pressure) and moderate suctioning may help remove secretion, reverse atelectasis and aid in the reexpansion of lungs.


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Feb24
Cystic Fibrosis
Introduction
Cystic fibrosis is a genetic condition in which the lungs and digestive system become clogged with thick sticky mucus.
Symptoms usually start in early childhood and include:
Persistent cough
Recurring chest and lung infections
Poor weight gain
Symptoms of cystic fibrosis usually become apparent in the first year of life.
An early sign is that an affected child’s sweat is unusually salty, which can be noticeable when you kiss your child.
Treating cystic fibrosis
There is no cure for cystic fibrosis. So the aim of treatment is to ease the symptoms and make the condition easier to live with. Treatment can also prevent or reduce long-term damage caused by infections and other complications.
Treatment options include:
Bronchodilators – which are a type of medication that helps expand the airways inside the lungs making it easier to breathe
Antibiotics – to treat chest and lung infections
Physiotherapy – there are a range of exercises that can help clear mucus from the lungs
In some cases a lung transplant may be required if the lungs become extensively damaged.
What causes cystic fibrosis?
Cystic fibrosis is caused by a genetic mutation; specifically a mutation in a gene called CFTR. A genetic mutation is when the instructions found in all living cells become scrambled in some way, meaning that one or more of the processes of the body do not work in the way they should.
The CFTR mutation allows too much salt and water into cells. This results in a build-up of thick, sticky mucus in the body's tubes and passageways. These blockages damage the lungs, digestive system and other organs, resulting in the symptoms of cystic fibrosis.
Who is affected
Cystic fibrosis is most common in white people of northern European descent.
The condition is much less common in other ethnic groups.
Screening
A small amount of the baby's blood is taken by a heel prick and transferred onto a card. The blood sample on the card is then analysed in the laboratory for cystic fibrosis and other inherited conditions, such as sickle cell anaemia.
Outlook
In previous years most children with cystic fibrosis would die of related complications before reaching adulthood.
The outlook has improved considerably in recent years due to advancements in treatment, although most people with cystic fibrosis will have a shorter than average life expectancy. However, this may well improve in the future.
Symptoms of cystic fibrosis
When a child is born with cystic fibrosis, symptoms usually appear in the first year, although occasionally they develop later.
The thick sticky mucus in the body affects a number of organs, particularly the lungs and digestive system
The symptoms and related problems of cystic fibrosis can vary in severity from person to person.
The main symptoms and problems are detailed below.
Lungs
It is common for people with cystic fibrosis to have difficulties such as:
Persistent coughing and wheezing; the body tries to shift the thick mucus in the lungs by coughing it up
Pecurring chest and lung infections; infections are caused by the continual build-up of mucus in the lungs, which provides an ideal breeding ground for bacteria
Cross-infection
People with cystic fibrosis are vulnerable to harmful lung infections caused by certain strains of bacteria (these bacteria are rarely harmful to people without cystic fibrosis).
Two strains of bacteria that commonly infect people with cystic fibrosis are Pseudomonas aeruginosa and Staphlyococcus aureus. They multiply in the thick mucus inside the lungs and may cause serious health problems, such as repeated chest infections.
The danger is that a person with cystic fibrosis who has such an infection can easily pass it on to another person with cystic fibrosis through close personal contact or by coughing near them. This is known as cross-infection.
As more and more people with cystic fibrosis become infected with these bacteria, the bacteria may become resistant to antibiotic treatment, which is why cross-infection is such a problem.
There is a concern that people with cystic fibrosis are more likely to pick up strains from each other than from the environment. For this reason, it is recommended that people with cystic fibrosis do not come into close contact with each other.
Patients infected with these dangerous bacteria may be treated in separate clinics to those without the bacteria, to avoid cross-infection.
Digestive system
Cystic fibrosis can also cause mucus to block the ducts in the pancreas. The pancreas produces essential food-digesting enzymes. When it is blocked, not enough of the enzymes reach the intestines to help break down food, which can cause a number of troublesome symptoms. These are outlined below.
Large, smelly stools
If the digestive enzymes are not being produced, food is not adequately digested and excess fat is lost in the stools (‘poo’), making them bulky, oily, smelly and difficult to flush away.
Malnutrition
Because the body cannot digest essential nutrients in food (particularly fat), it is often difficult to gain weight and infants may struggle to put on weight and grow. The medical term for not consuming sufficient nutrients is malnutrition.
Adults with cystic fibrosis often find it difficult to gain and maintain weight. In children with cystic fibrosis, this can result in delayed puberty if they are severely underweight.
Diabetes
In older people with cystic fibrosis, the pancreas can become more damaged. Diabetes can develop if the pancreas does not produce enough insulin, a hormone that controls the level of sugar in the blood.
Diabetes in people with cystic fibrosis is different from diabetes in people without cystic fibrosis. Usually, the symptoms of diabetes include feeling constantly thirsty, frequently needing to pass urine and feeling extremely tired.
This is less common in people with cystic fibrosis. Instead people with cystic fibrosis who develop diabetes may find it difficult to gain weight or may lose weight and see a decline in their lung function.
Cystic fibrosis-related diabetes is usually controlled by regular injections of insulin. Diabetes rarely occurs in children with cystic fibrosis.
Ears, nose and sinuses
People with cystic fibrosis can be prone to sinusitis (an infection of the cavities behind the cheekbones), which may need to be treated with nasal sprays or antibiotics.
Some older children and adults develop nasal polyps, which are fleshy swellings that grow from the lining of the nose or sinuses. If they become troublesome, they may need to be removed.
Bones and joints
Some older children with cystic fibrosis develop a form of arthritis(swelling and pain of the joints), usually in one or two large joints such as the knee. In most cases, symptoms improve with time and treatment.
Older children and adults may also be prone to thin bones, for many reasons, including repeated infection, poor growth or weight, lack of physical activity and lack of vitamins and minerals due to digestive problems.
People with cystic fibrosis are more at risk of developing osteoporosis if they are taking steroid medication (corticosteroids) to help with lung infections. Osteoporosis can cause joint pain and bones may fracture (break) more easily. Some people need to take drugs called bisphosphonates to help maintain their bone density.
Infertility
Both men and women with cystic fibrosis can have problems conceiving children.
In virtually all men with cystic fibrosis, the tubes that carry sperm do not develop correctly, making them infertile.
Women with cystic fibrosis may find that their menstrual cycle becomes absent or irregular if they are underweight.
There is also an increased thickness of cervical mucus, which can sometimes reduce fertility.
However, some women with cystic fibrosis can have a successful pregnancy, though it may take longer than usual before conceiving a baby.
Liver
In a few people with cystic fibrosis, the tiny bile ducts in the liver can become blocked by mucus. This can be serious as the disease progresses, and in some cases it may be necessary to have a liver transplant.
Incontinence
People with cystic fibrosis, especially females, are more likely to have urinary incontinence (loss of bladder control) as urine can leak out of the bladder during coughing fits.
Causes of cystic fibrosis
Cystic fibrosis is a genetic condition. It is caused by a faulty gene (known as the CFTR gene) that blocks the normal workings of a protein. This then allows too much salt and not enough water into cells.
This results in a build-up of thick, sticky mucus in the body's tubes and passageways. These blockages damage the lungs, digestive system and other organs, resulting in inflammation (swelling) and, in the lungs, repeated infections.
How the CFTR mutation is passed through families
Genes come in pairs. You inherit one set of genes from your mother and one set from your father.
To develop cystic fibrosis you would have to inherit the faulty gene from both your mother and your father.
A carrier can be completely healthy and have no symptoms of cystic fibrosis.
If two carriers of the faulty gene have a baby, there is:
A one-in-four chance that the child will not inherit either of the faulty genes (the child will not have cystic fibrosis and will not be a carrier of the condition)
A one-in-two chance that the child will inherit one copy of the faulty gene from either their father or mother (the child will not have cystic fibrosis but will be a carrier of the condition)
A one-in-four chance that the child will inherit both copies of the faulty gene (the child will have cystic fibrosis)
Diagnosing cystic fibrosis
Most cases of cystic fibrosis are now identified through screening tests carried out early in life. However, some babies, children and even young adults are identified later following unexplained illness.
Diagnosing cystic fibrosis
There are three main ways of diagnosing cystic fibrosis:
Newborn testing
Antenatal testing
Sweat testing
Newborn screening
A small amount of the baby's blood is taken by a heel prick and transferred onto a card. The blood sample on the card is then analysed in the laboratory for cystic fibrosis and other inherited conditions, such as sickle cell anaemia.
The sooner cystic fibrosis is diagnosed, the sooner treatment can begin and the better the outlook.
Antenatal testing
A test can be done on a woman when she is pregnant to see if her unborn baby has cystic fibrosis. This can be carried out from 10 weeks of pregnancy.
The test uses chorionic villus sampling (CVS), where a fine needle is passed through the abdomen into the womb. Sometimes, a fine tube is passed through the vagina into the cervix (neck of the womb) instead. A tiny piece of the developing placenta, known as the chorionic tissue, is taken and the chromosomes in the cells of the tissue are examined for the faulty gene that causes cystic fibrosis.
Antenatal testing for cystic fibrosis is usually only offered to mothers who are thought to be at high risk of having a child with the disease, such as women with a family history of the condition.
Sweat test
If someone has cystic fibrosis, their sweat will have higher levels of salt than normal. A parent may first notice their child's symptoms of cystic fibrosis when they kiss them, as their skin can taste salty.
A sweat test measures the amount of salt in sweat. It is usually done by applying a very weak and painless electric current to a small area of skin to which a harmless chemical has been applied. This causes that area of skin to sweat. A sample of the sweat is then collected and analysed. If the salt content in the sweat is abnormally high, this confirms cystic fibrosis.
A sweat test may be carried out if:
Newborn screening tests are abnormal
A child has symptoms of cystic fibrosis
A child is born with a serious bowel obstruction known as meconium ileus
A child or adult has symptoms suggestive of cystic fibrosis
Genetic testing
A genetic test checks for the faulty cystic fibrosis gene by either analysing a saliva sample taken from inside the cheek using a swab or a blood sample. It can be useful to confirm cystic fibrosis if a sweat test gives a borderline result.
It can also be useful to find out which members of a family are carriers of the cystic fibrosis gene.
Carrier testing
There is a simple test that uses a mouthwash to identify whether a person is a carrier of the cystic fibrosis gene.
Swishing the mouthwash collects a sample of cells from the mouth. This sample is then sent to a laboratory and the cells it contains are checked for the faulty cystic fibrosis gene.
It is important to have this test if the person’s partner is a known carrier, or if someone in the family has cystic fibrosis or knows that they carry it.
Testing in later life
Older children and adults may require regular testing to check how well (or not) their lungs and digestive system is working.
Tests that can be used for this purpose are described below.
Spirometry
You will be asked to breathe into a machine called a spirometer.
The spirometer takes two measurements: the volume of air you can breathe out in one second (called the forced expiratory volume in one second or FEV1) and the total amount of air you breathe out (called the forced vital capacity or FVC). You may also be given a type of breathing test known as a spirometry.
You may be asked to breathe out a few times to get a consistent reading.
The readings are compared with normal measurements for your age, which can show if your airways are obstructed.
Chest X-rays
A chest X-ray can be a useful method for assessing the state of your lungs
Computerised tomography (CT) scan
In a CT scan a series of X-rays are taken; these are then assembled by a computer into a more detailed ‘3D’ image of your lungs and digestive system.
Treating cystic fibrosis
People with cystic fibrosis should be treated with help and advice from a team of healthcare professionals at a cystic fibrosis centre. With regular visits, the patient or parent can learn how to best manage the condition. As each case is different, they can receive tailored care for their or their child's condition.
There is no cure for cystic fibrosis. The aim of treatment is to ease the symptoms and make the condition easier to live with. It can also prevent or reduce long-term damage caused by infections and other complications.
Different types of treatment for cystic fibrosis are detailed below.
Medication
Medical treatments for cystic fibrosis help clear and control infections in the lungs and digestive system. They can also be used to treat some of the other health problems related to cystic fibrosis.
Bronchodilators
Bronchodilators are a type of medication that are inhaled to help the person breathe more easily. They are also used for asthma and relax the muscles that surround the airways in your lungs, helping them to open up.
Antibiotics
Antibiotics are taken to fight infections in the lungs. They can be taken by mouth as pills, capsules or liquids, be inhaled through a nebuliser (a device that turns medication into a mist that can be breathed in), or they may be given intravenously (through a tube into a vein) if the infection is more severe.
All young children diagnosed with cystic fibrosis will be started on a course of antibiotics to protect them from certain bacteria, which will be continued for some years. For more advice on the use of antibiotics, see the Cystic Fibrosis Trust information on medication.
Corticosteroids
Steroid medication (corticosteroids) reduce the swelling of the airways, which can help with breathing in some patients. Steroid nasal drops and sprays can also be used to treat nasal polyps (small growths inside the nostrils).
Pulmozyme
Pulmozyme (DNase) is an enzyme, usually inhaled via a nebuliser, which helps to thin and break down the sticky mucus in the lungs so it is easier to cough up.
In most cases DNase will not cause any noticeable side effects
Insulin
People who have diabetes as a result of their cystic fibrosis will need to take insulin and manage their diet to stabilise blood sugar levels. The dietary advice usually given to people with diabetes who do not have cystic fibrosis does not apply to most people with cystic fibrosis-related diabetes.
Bisphosphonates
Bisphosphonates can be taken to treat osteoporosis (weak and brittle bones), which can occur as a result of cystic fibrosis. Bisphosphonates help maintain bone density and reduce risk of fractures.
Vaccinations and flu jabs
It is particularly important that people with cystic fibrosis are up to date with all the required vaccinations. People with cystic fibrosis should make sure they have an annual flu jab, as they are more susceptible to complications as a result of infection.
Digestive system, diet and nutrition
For people with cystic fibrosis, getting the right nutrition is vital. A healthy body weight is necessary to help fight off infections, and it is important there is enough reserve energy to rely on when the person is ill.
Cystic fibrosis causes mucus to build up and block the small channels that carry digestive juices and enzymes. Over time, this causes the pancreas to become damaged. The effect of cystic fibrosis on the pancreas varies from person to person, but most people have to take digestive enzymes from birth to help them digest food and get the nutrients they need, with every meal and snack. They also need to take vitamin supplements.
The diet of someone with cystic fibrosis should be high in calories, as they will not be able to digest all the food they eat.
A special diet should start as soon as cystic fibrosis is diagnosed, which will need to be adapted as people get older.
Babies with cystic fibrosis
Babies with cystic fibrosis may be breastfed as usual, otherwise most baby milks and formulas will be suitable. In some cases, if the baby is not gaining enough weight, a high-energy formula may be needed or nutritional supplements added to milk feeds to give the baby more calories (energy).
Ask a dietitian at the cystic fibrosis centre if you are unsure about this.
Before a baby moves onto solid foods, they may need extra salt as both breast milk and baby milk are very low in salt. Cystic fibrosis makes sweat much saltier and more salt than normal is lost through skin.
If the baby needs extra salt, the dietitian or doctor at the cystic fibrosis centre will advise on the appropriate amount and prescribe a salt solution.
Never add salt to a baby's food or drink without specific advice from cystic fibrosis specialists.
Babies can eat any normal solid baby foods, but they will need vitamin supplements to compensate for the loss of vitamins A, D, E and K in their stools.
These are available in two liquid preparations. Vitamins A and D are usually combined in one, and there is usually a separate one for vitamin E. Vitamin K is now prescribed by many doctors to older children.
A baby with cystic fibrosis will also need pancreatic enzymes to help them digest food. These take the place of the food-digesting enzymes missing from their digestive system. They usually come in the form of microspheres or minimicrospheres (granules), which can be mixed with a little formula, expressed breast milk or fruit puree and spoon fed ideally at the start, during and after the feed.
The granules should never be given dry as they can be a choking hazard. A dietitian can advise on the amount to use and the most suitable way to give the enzymes.
Children with cystic fibrosis
Children who have cystic fibrosis should eat a varied diet, with a large amount of protein and calories. Meals should include meat, fish and eggs, as well as starchy foods like bread and pasta. If a child's appetite is poor, give them food little and often, and offer snacks in between meals.
Children who find it particularly hard to gain weight can be given dietary supplements in the form of milk shakes or fruit juices. You can talk to a cystic fibrosis dietitian about these.
Like babies, children with cystic fibrosis will need to continue taking vitamin A, D, E and K supplements to compensate for the vitamins they lose.
Children also need to continue taking pancreatic enzymes with all fat-containing meals, snacks and drinks. The capsules should be taken before and during the meal and the number of capsules will vary depending on the fat content of the meal. Enzymes can be taken in easy-to-swallow capsules.
A dietitian may recommend salt supplements for a child with cystic fibrosis, especially in hot weather or if they are going on holiday to a country with a warm climate, where sweating may cause a loss of salt.
Children with cystic fibrosis are likely to eat more sugary foods than normal due to their high-calorie diet, so it is important to make sure they brush their teeth properly and visit the dentist regularly.
If a child cannot gain enough weight and dietary supplements have not helped, they may need to be tube fed.
This will usually be either nasogastric (the tube is inserted through the nose and goes down to the stomach), or gastrostomy (a small operation is carried out to insert the tube directly into the stomach). The other end of the tube is attached to a bag of high-calorie/nutrient food that is delivered straight to the stomach, usually while the child sleeps.
Adults with cystic fibrosis
Adults who have cystic fibrosis do not need to avoid any particular food, but it is important they have a diet high in protein and energy to maintain their weight. They should eat regular meals and snacks as this helps to maintain energy intake. They should eat three meals a day, including plenty of meat, fish and eggs, and eat several high-calorie snacks in between.
If someone with cystic fibrosis wants to be a vegetarian, they should talk to their dietitian about alternatives to meat. A vegan diet is not advised for people with cystic fibrosis as it tends to be especially low in energy.
Most adults with cystic fibrosis need to continue taking pancreatic enzymes with all fat-containing meals, snacks and drinks. The capsules should be taken before and occasionally during the meal and the number of capsules will vary depending on the fat content of the meal. There are different types and strengths so talking to the cystic fibrosis specialist team will help the person find one that suits them.
People with cystic fibrosis should not stop taking pancreatic enzymes unless they are told to do so by their dietitian or doctor, as this can lead to a serious blockage of the bowel.
Most adults need to continue taking vitamin A, D, E and K supplements. These come in the form of prescribed multivitamin tablets.
People with cystic fibrosis who lose a lot of weight due to an infection or illness may need to be tube fed to help them gain weight.
As in tube feeding for children, this will be either nasogastric or gastrostomy, depending on how long the tube must stay in for. A gastrostomy tube (which is inserted directly into the stomach) is best for longer periods of time or repeated courses of treatment as it is unlikely to be dislodged during coughing or physiotherapy.
Physiotherapy
The management of cystic fibrosis with physiotherapy differs for each person with the condition, and is specifically tailored to their needs.
Traditionally, physiotherapy for cystic fibrosis focused mainly on airway clearance (clearing mucus from the lungs). This still makes up a large part of daily treatment, but the role of the physiotherapist in cystic fibrosis has expanded to include daily exercise, inhalation therapy, posture awareness and, for some, the management of urinary incontinence.
Airway clearance
It is beyond the scope of this article to discuss all of the airway clearway techniques available (your care team should be able to provide more information on airway clearway techniques).
The most widely used is called active cycle of breathing techniques (ACBT).
Active cycle of breathing techniques (ACBT)
ACBT involve you repeating a cycle made up of a number of different steps. These are:
A period of 20-30 seconds of normal relaxed breathing
3-4 deep breaths, where you hold each breath in for three seconds before breathing out
‘Huffing’ – huffing involves taking a medium size breath in followed by a fast breath through your open mouth while using the muscles of your chest and stomach to help force the breath out – this should help push the mucus / up to a point where you can cough it out
Coughing – you should then cough every 2-3 huffs; but don’t try to force out sputum if it does not feel ready to be coughed out
You then repeat the cycle for 20-30 minutes.
(Do not attempt ACBT if you have not first been taught the steps by a suitably trained physiotherapist as performing the techniques incorrectly could damage your lungs).
If you are otherwise in good health you will probably only need to perform ACBT once or twice a day.
If you develop a lung infection you may need to perform ACBT on a more frequent basis.
Postural drainage
Changing your position can also make it easier to remove mucus from your lungs. This is known as postural drainage.
Each technique can involve a number of complex steps but to summarise, most techniques involve you leaning or lying down while the physiotherapist or a carer uses their hands to vibrate certain sections of your lungs as you go through a series of ‘huffing’ and coughing.
Devices
There are also a number of devices that can help remove mucus from your lungs. These include:
The flutter – which is a handheld advice, shaped like an asthma inhaler, which delivers vibration to the airway of your lungs, making it easier to cough out mucus
RC cornet – which is shaped like a small section of garden hosing which works in much the same way as the flutter
The Acapella – which is a device, shaped like a small torch, that uses a combination of vibration and air pressure to help remove mucus
Some techniques use large pieces of equipment, which can be very expensive and are usually only available for use in a hospital, such as a high frequency chest wall oscillation (HFCWO). This involves using an electric air compressor that connects to an inflatable jacket (vest) to vibrate the chest
Exercise
Exercise is recommended for everyone with cystic fibrosis. This may vary from taking part in normal school activities to individualised exercise programmes. Infants and toddlers with cystic fibrosis should have some exercise included in their normal daily routine.
Any sport or exercise that gets a person with cystic fibrosis moving is good, but if there are any concerns or worries, they should ask their physiotherapist.
Children and adults are also encouraged to include stretching exercises into their routine to mobilise the joints and muscles around their chest, back and shoulders, and to be aware of maintaining good posture.
Lung transplants
In severe cases of cystic fibrosis, when the lungs stop working properly and all medical treatments have failed to help, a lung transplant may be recommended.
Both lungs need to be transplanted as they will both be affected by the condition. A lung transplant is a serious operation that carries certain risks, but it can greatly improve the length and quality of life for people with severe cystic fibrosis.
The outlook for people with cystic fibrosis is often better than average for transplant patients as they are often younger and in better health than other transplant candidates.


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Oct29
This Diwali remember – What you burn is what you breathe!
As sure as Diwali is a festival of lights, sweets, gaiety, splendor & fireworks, it is also one of deafening noise, blinding light, risky fire & suspended particles. And this has direct effects on our health & environment. When the entire nation looks forward to Diwali as a celebration of life, patients suffering from Asthma & COPD (Chronic Obstructive Pulmonary Disease) begin readying there lifesavers – Inhalers, nebulizers or whatever gives them a breath of life. For these people Diwali is not a festival of light & gaiety but that of smoke, coughing & wheezing.

Fireworks are sources of some of the highly toxic inhalants produced during Diwali celebrations. Firecrackers are “power packed” with potassium nitrate, carbon & sulfur. Apart from this they also contain toxic contents like copper, cadmium, lead, manganese, magnesium, zinc, sodium, potassium, and aluminum powder & barium nitrate. When ignited, the crackers burst allowing these powerful chemicals to come in contact with atmosphere and the smoke thus generated contains increased amounts of carbon monoxide, carbon dioxide, nitrogen dioxide, hydrocarbons, hydrogen sulfide & particulate matter which worsen the quality of Diwali air. The suspended particles hog like a thick blanket reducing visibility and suffocating the atmosphere. In fact studies have demonstrated that during Diwali festival the concentration of sulfur dioxide increased by 10 times & that of nitrogen dioxide, PM10(Particulate matter of size less than 10 microns) & TSP(Total Suspended Particles) increased by 2 to 3 times. The Overall air pollution during Diwali increases by about 200 %. The biggest culprits among firecrackers are the colour sparkles (“Phuljari”), “Anar”, “Chakri”, Fire pencils, Snake tablets & “Hydrogen” bomb.

A special mention may be made of PM10. With the average PM10 charge, we inhale millions of fine particles with each breath. The larger particles( 5 to 10 microns) are filtered in the nose & throat, smaller particles (3 to 5 microns) arrive in the bronchial tube, bronchi (2 to 3 microns), bronchioles (1 to 2 microns) & in alveoli (0.1 to 2 microns) & finally in the blood. These particles can no longer be coughed up & as deposits lead in long term to inflammation, particularly in asthmatics, & also with healthy people, although they may not notice the immediate irritant effects.

When we inhale such a highly toxic and polluted air during Diwali, how can escape from its ill effects? The harmful oxides present in the Diwali fumes come into contact with the moisture while passage from the nostrils to the lungs & form acids which cause immense damage to the body.

The Diwali smoke potentially leads to development of various respiratory ailments like –Allergic bronchitis, acute exacerbation of bronchial asthma & COPD (Chronic Obstructive Pulmonary Disease), allergic rhinitis, laryngitis, sinusitis, pharyngitis, common cold, acute eosinophilic pneumonia, reactive airway dysfunction syndrome, etc.

Children, pregnant women, asthmatics & senior citizens are highly prone to these potentially harmful effects of Diwali smoke.

Here is a list of precautions that need to be followed during Diwali celebrations.

Precautions to be followed by asthmatics:

1. Stay away from people burning crackers.

2. Keep the inhalers and other medicines ready beforehand (both maintenance & reliever medications).

3. Consult your doctor and start maintenance dose of inhalers a few days before the festival & continue the same two days after Diwali.

4. In severe cases rescue medications need to be taken & if not relieved contact your doctor immediately.

5. Better do not venture out in the evening of Diwali. Stay in company of friends and family members in house.

6. If need to venture outside use masks (N95 masks have been technically recommended).

7. Consult your doctor regarding pulmonary vaccination in advance.

8. Stay away during colouring and white washing of house before Diwali because these also act as “triggers” of an asthma attack.

9. If possible plan a visit to some hill-station / ecoclean place (which is not much crowded) during Diwali festival.

Precautions to be followed by every one of us during Diwali festival:

1. Avoid /decrease the firework celebrations & play “ecosafe” Diwali.

2. Enjoy Diwali with lamp, lanterns & diyas.

3. Fireworks if carried out should be done in open grounds, away from residential areas & during fixed time limits.

We should remember that one person’s idea of fun could be an asthma patient’s nightmare. Asthma patients have as much right as us to stick around and enjoy Diwali. And ultimately for our own benefit we should not forget that “what we burn is what we breathe”, this Diwali.


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Oct29
Home Oxygen Therapy
The following article shares the information of home oxygen therapy in question answer format which can be understood by every body. In today’s era home oxygen therapy is advicated in many lung diseases and we all need to know about it.

HOME OXYGEN

Everybody Needs Oxygen:

Oxygen is essential for life. One of the reasons why life exists on earth and not on mars or on moon is because earth’s atmosphere contains 21% of oxygen.Our lungs inhale the atmospheric air through the nose. In the lung, there are air sacs (about 30 crores of them) called alveoli, which transfer oxygen into blood. Of course we all know that blood carries oxygen from lungs to every little organ, tissue and cell of the body.

Lungs with severe Disease can’t perform well:

Lungs have a very remarkable reserve capacity to withstand the onslaught of disease. But when the extent of lung disease is large, the lungs are unable to perform well and thus are unable to transfer enough oxygen in blood. These include disease like chronic bronchitis & emphysema caused by tobacco smoke, diffuse interstitial pulmonary fibrosis, chronic persistent severe asthma and some cases of lung cancer.

When is home oxygen prescribed?

Normally arterial bloods (‘the good blood’) contain about 90 units of oxygen (90mmHg in scientific term. But in some of the diseases as mentioned earlier, inspite of all the drugs (eg. Antibiotic & other medicines like bronchodilators) the lungs may be unable to sustain an oxygen level of 90 units in blood. As disease advance & physiological derangement worsens the blood oxygen level may fall to less than 60 units! At this point the person suffer from sustained breathlessness, aggravated further even by slightest of the activity like shaving, combing hair, walking a few steps, eating etc.,

What are the effects of low oxygen in blood?

Low oxygen in blood is called Hypoxia by doctor. Apart from producing breathlessness, rapid breathing
Palpitation anxiety, the person will also experience intense lethargy, fatigue (tiresomeness) initability, incoherent talk etc., low oxygen also increase the work load on the heart which eventually in unable to perform it’s pumping action well. What is most important to remember is that low oxygen levels in blood eventually affect the quality of life & length of life span.

What is Home Oxygen?

In the earlier year oxygen was given to patients only in the hospitals, later, several well-planned scientific studies showed that quality & quantity of life can be improved dramatically by using oxygen at home.

How long should one use Oxygen?

This question will basically be answered by the concerned doctor, but generally use of oxygen at home is life long.

How many hours in a day?

There were several scientific studies on this issue & expert finally concluded that Oxygen for 8 hours is good, Oxygen for 15 hours is better but Oxygen for 24 hours is best.


How can I get oxygen at home?

There are three way of using oxygen at home:

A) OXYGEN CYLINDERS: You are familiar with its appearance & use. An average cylinder runs about 48 hrs if you use at 2 liters per minutes, but may get exhausted sooner if you use at the rate of 4 liters per minutes.

Advantages: The only advantage of Oxygen cylinder is the easy availability & low initial investment ( refundable deposit of Rs. 5000/- to 1000/- : Cylinder refilling Rs.350 Per cylinder:rent for cylinder Rs. 5/- Per day: Transportation charges (eg Auto )Rs. 50/- to 100/- each time.

Disadvantage:
1. Need for frequent refilling
2. Hassles of transporting
3. Explosion hazards
4. Un predictability (you never know when the cylinder gets exhausted.
5. Huge expenditure ( appox. Rs. 70000/- per year) in the long run.

B) OXYGEN CONCENTRATOR: Are machines, which run on electricity, & has very specialized high efficiency compressors, to extract oxygen from atmosphere & concentrate to 95% pure gas. Its weight about 22 Kg & has caster wheels for easy mobility.
Advantage:
1) Safe, silent, Efficient & convenient
2) No recurrent Expenditure
3) No frequent hassles of transportation
4) Low maintenance cost

Disadventage:
1) Expensive Rs. 60000/-
2) Needs Electricity (although can run on car battery or inverter)

C) LIQUID OXYGEN: Packed in small tanks, the size of a large thermos flask. One refilling can run for almost 2 to 3 day.

Advantages:
Handy, portable, easy to use

Disadvantage:
1) Very expensive (exact cost known)
2) Not available in India

What about the mask etc:

Oxygen can be used through either a soft nasal prongs or a face mask

Nasal Prongs: Are easy to put on, light, convenient & more acceptable it allows you to eat, drink & talk.

Face mask: uncomfortable to wear for long hours. Ideally suited for use at nights.


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Oct29
Public Private Mix in treatment of Tuberculosis
The article discusses the role Public Private Mix in treatment of Tuberculosis in current scenario especially in a country like India.

Accountability is a fundamental principal of TB control.

In many countries, significant proportion of patients with TB first consult Private health practitioners.

Characteristics of poor management of TB patients in private sector:

1. Diagnosis by chest xray without smear examination.
2. Overuse of unnecessary and expensive tests.
3. Under treatment.
4. Over treatment.
5. No supervision.
6. No follow up of late patients.
7. Inappropriate monitoring of treatment by Chest Xray.
8. Inadequate treatment records.
9. No reporting.

There is no one means to achieve coordination between public and private sectors in all countries. The various approaches to strengthening the coordination between public and private sectors include the following:

1. Competition:

Well organised out patient chemotherapy, especially if provided free of charge, will attract asymptomatic cases from far and wide.

2. Exclusion:

-Exclude the private sector.
-Ban over the counter sale of anti tubercular drugs.

3. Contracting:
Public sector can contract TB control services to private groups.

4. Engagements:

-Actively engage private sector in TB care.
-In many countries, public health programmes & professional groups such as National Chest Societies, collaborate to establish standards of care that apply to both public and private sectors & revise medical colleges curricula to reflect these consensus standards.
-The following services should be made free:
*Lab services
*transportation of specimens
*referral to public sector
*free medications

5. Reporting:

Include making compulsory the following:
-Active surveillance of laboratories.
-Reporting of bacteriologiocaly confirmed patients.
-Monitoring of these patients.

Role of NGOs:

1. Educate private practitioners to adopt RNTCP (Diagnostic & treatment policies, treatment referral).
2. Provide diagnostic & treatment services to which private patients can be referred.
3. Provision of outreach workers in community for follow up of late patients.
4. Assisting in recording and reporting of cases.
5. Act as links with Chest Physicians, Paramedics, etc.

Government has recently introduces a 5 pronged programme for involvement of NGOs in RNTCP which includes the following 5 levels:

level 1: Outreach services, Education
level 2: DOT treatment
level 3: Hospital services
level 4: Microscopy centres
level 5: Model treatment services/centres

This carries a great relevance in today's scenario when we are striving hard to fight against Tuberculosis.

The take home message is involvement of all in providing health care services in tuberculosis.


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Sep02
Diaphragmatic Pacing
Patients with chronic apnea, either due to cervical spine trauma or diseases, such as ALS, may benefit from Diaphragmatic Pacing.

Improvement in the quality of life has been demonstrated in these patients by delaying the need for mechanical ventilation and decreasing the incidence of pulmonary infections.

Phrenic nerve stimulation or direct diaphragmatic stimulation are preformed via implanted electrodes connected to a radiofrequency receiver which receives radio signals from an external transmitter.

Candidates for phrenic nerve stimulation must have intact phrenic nerve cell bodies, therefore patients with lower motor neuron diseases, such as ALS or damage to the cervical spine bellow C2, may be treated with direct diaphragmatic pacing only.

The electrodes are placed using minimally invasive surgical techniques. Phrenic nerve pacers are placed using cervical or thoracic approaches. Diaphragmatic pacers are placed laparascopically at diaphragmatic motor points, attachment points of the phrenic nerve on the diaphragm. These points are mapped using specialized computer software.

This procedure was developed at University Hospitals Case Western Medical Center. Patients include Christopher Reeves, who suffered a cervical spine injury following a riding accident leaving him quadriplegic and respirator dependent.

Reeves: "“The constant and high cost of care for ventilator-dependent patients not only exhausts most insurance policies but contributes to strain on families and caregivers. Once this procedure receives FDA approval, these patients and their caregivers should be able to achieve significant improvements in their quality of life.”

This procedure has been FDA approved since 2008 and is now gaining worldwide accreditation for its role in ICU patient rehabilitation.


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