Common
diseases
The department
of chest medicine has been functional at Sir Ganga Ram Hospital since
1993. It provides all that is necessary for high quality care of patients
viz. excellent manpower resources in its consultants and post graduate
residents, state-of-the-art equipment required for diagnosis and treatment
of respiratory diseases, a humane approach combined with total dedication
and academic activities to always remain abreast with the latest
developments in the field of respiratory medicine.
The department
has a fully equipped pulmonary function test laboratory able to
perform spirometry, lung volume and diffusion studies-in short a
comprehensive lung function testing facility.
Bronchoscopy
is an integral part of the diagnostic and therapeutic armamentarium of any
modern pulmonology unit and we have a videobronchoscopy unit which enables
high resolution imaging as well as performance of procedures such as
transbronchial lung biopsies, transbronchial needle aspirations as well as
the routine sample collection.
Allergy
testing and immunotherapy are making a comeback in the management of
allergic respiratory diseases and this department offers the full range of
allergy tests.
With an
intensive care unit in the hospital, which compares with the best in the
world, we are able to offer treatment to patients with respiratory failure
due to any cause and this is supported by a huge expertise within the
department in non-invasive ventilatory support both within the hospital
and for domiciliary care.
Advice on
domiciliary oxygen therapy to enable patients with chronic respiratory
failure to lead useful quality lives and pulmonary rehabilitation to help
the same group of patients are some of the other areas which are
developing rapidly within the department.
With the ever
increasing burden of respiratory diseases, we in Sir Ganga Ram Hospital's
department of chest medicine, offer services that we can say are at par
with the best in the world.
Special
programme
Pulmonary Rehabilitation
Asthma
is a long-term (chronic) disease of the airways which are involved in
carrying air in and out of the lungs. Its symptoms are caused by
inflammation, which makes the airways red, swollen, narrower and
extra-sensitive to irritants. This leads to recurrent attacks of wheezing,
breathlessness, chest tightness and coughing. Asthma does not stay the
same, but changes over time, and every person with asthma has good and bad
days. However, if asthma is properly treated, one can enjoy long periods
without symptoms or attacks. The causes of asthma are not fully
understood. Asthma is usually caused by a mixture of hereditary (which a
person is born with) and environmental factors.
Allergens from house dust mites and pets are the most common causes, but
many other allergens, such as pollen and moulds, can cause asthma. Some
patients with asthma have no obvious allergies.
Treatment of
asthma requires two types of medicines, preventers and relievers.
Preventers are medicines that prevent asthma attacks from starting. The
most effective and most commonly used preventer medicines are inhaled
glucocorticosteroids. Reliever medicines, like inhaled salbutamol,
Salmeterol etc, provide rapid relief from an asthma attack by quickly
opening up the narrowed airways (dilating the bronchi).
Asthma is
underdiagnosed and undertreated. Worldwide, approx. 180,000 deaths
annually are attributable to asthma. Asthma places considerable limitation
on the physical, emotional, social, and professional lives of suffer.
Children can become very distressed by their disease with considerable
absences from school and reduced participation in family life.
The department
of chest medicine fully realising the requirements of asthma patients, has
adopted the six-point management plan, as per the GINA guidelines, which
involves-
-
Educating
patients to develop a partnership in asthma management
-
Accessing
and monitoring asthma severity with symptom reports and measures of
lung function as much as possible.
-
Avoiding
exposure to risk factors.
-
Establishing
medication plans for chronic management in children and adults.
-
Establishing
individual plans for managing exacerbations.
-
Providing
regular follow-up care.
Chronic
Obstructive Pulmonary Disease (COPD) is a slowly
progressing lung disease, which makes it difficult to empty air out of the
lungs. It is an insidious disease, which often first is diagnosed when
about half of the lung capacity is lost. Thus, it is possible to have COPD
without knowing it. However, the diagnosis is easily made, by measuring
the pulmonary function. An early diagnosis is important, as once lost
capacity cannot be regained.
COPD has two
main components, chronic bronchitis and emphysema. In chronic bronchitis,
the lining in the breathing tubes (airways) becomes red, swollen and
produces excess mucus. Mucus blocks the air tubes making it difficult to
breathe.
In emphysema the
air sacs (alveoli) become damaged, less elastic and permanently dilated.
This makes it difficult to push all of the air out of the lungs, the lungs
do not empty efficiently and therefore contain more air than normal. The
fresh air cannot enter freely making it difficult for oxygen to get into
the blood and carbon dioxide to leave the blood. Therefore, extra effort
is needed to breathe resulting in a person feeling short of breath.
Cigarette
smoking is the most common cause of COPD. Smoking causes 80 to 90 percent
of all COPD. Environmental factors and genetics may also cause COPD. For
example, heavy exposure to certain dusts at work, chemicals, and indoor or
outdoor air pollution can contribute to COPD.
The most common
signs of COPD are shortness of breath, cough, and/or sputum production
that does not go away. It needs visit to your doctor and evaluation for
the need of a breathing test called spirometry. It is a simple test done
to measure your lung capacity.
The first and
the most important treatment in smokers is to stop smoking. This is the
best way to keep COPD from worsening. Medications are usually given to
widen the airways (bronchodilators), reduce swelling of the airways
(inhaled steroids), and/or treat infection (antibiotics).
Good nutrition,
oxygen therapy, and exercise can give support to the treatment of COPD.
Pulmonary rehabilitation programs offer supervised exercise and education
for those with breathing problems.
COPD cannot be
cured. While symptoms may vary from time to time, the lungs can still have
disease, therefore, COPD is for life. By quitting smoking, taking regular
medication, learning to manage their condition after attending pulmonary
rehabilitation programme, patients can continue to lead a fulfilling life.
Tuberculosis
(TB) is a communicable, but curable bacterial infection caused by Mycobacterium
tuberculosis. The lungs are primarily involved, but the infection can
spread to other organs.
TB is spread
through the air when a person with TB in the lungs or throat coughs or
sneezes, sending TB germs in the air. When other people breathe in these
germs they may become infected. The primary stage of the infection is
usually asymptomatic (without symptoms). Pulmonary TB develops in the
minority of people whose immune systems do not successfully contain the
primary infection. In this case, the disease may occur within weeks after
the primary infection. TB may also lie dormant for years and reappear
after the initial infection is contained.
This TB
'infection' becomes ' disease' when the body's defences are weakened, due
to aging, a serious illness, stressful event, drug or alcohol abuse, HIV
infection (the virus that causes AIDS) or other conditions. When inactive
TB germs become active, they multiply and damage the lungs or other parts
of the body and the disease develops. Only about 10% of people infected
with TB germs develop TB disease.
Patients of TB
may develop some or all of the following symptoms-
-
Cough for
more than 3 weeks
-
Fever esp.
evening rise fever
-
Weight loss
-
Loss of
appetite
-
Night sweats
-
Sputum with
or without blood
-
Chest pain
A few patients
may not have any or very mild symptoms initially and their disease is
detected at a much later stage when the disease is far advanced.
Tests required
for diagnoses of TB are
-
Chest X-ray
-
Sputum test
to look for TB germs (AFB smear and culture)
-
Tuberculin
skin test (Montoux test)
-
Quantiferron
- G test for diagnosis of latent or active infection
-
Bronchoscopy
-
CT scan
-
Thoracentesis
Rarely, biopsy
of the affected tissue (typically lungs, pleura, or lymph nodeTreatment of
tuberculosis requires a six to nine month course with a combination of
special antibiotics. (Occasionally the course of treatment may take
longer). The antitubercular treatment is with combinations of rifampin
, isoniazid
, pyrazinamide
, ethambutol
, or occasionally others. The treatment requires regular supervision to
check for any side effects and make sure treatment is completed. People
with TB can continue treatment and normal activities when they are not
infectious.
People with TB
can be cured if they complete treatment. In most cases, after 2 weeks of
taking medication, patients with TB disease will no longer spread germs.
Irregular drug
taking may cause serious reactions, and the development of drug resistance
(MDR-TB), which can be difficult to treat. Therefore it is important to
take complete treatment.
Pneumonia
is an infection of the lungs. Pneumonia is a serious illness that can be
life-threatening if not treated, especially for persons who are older than
65 years, alcoholic, have underlying medical problems, or have a weakened
immune system. Pneumonia can be caused by a variety of microorganisms,
including viruses, bacteria, and less commonly, fungi.
Here we will
focus on community-acquired pneumonia (CAP), which refers to pneumonia
that develops in people in the community, not in a hospital, nursing home,
or assisted-living facility.
The mouth and
respiratory tract are constantly exposed to microorganisms as air is
inhaled through the nose and mouth. However, the body's defences are
usually able to prevent the lungs from becoming infected. CAP develops
when a person's defences are not adequate or the microorganism is
particularly strong. As microorganisms multiply, the alveoli become
inflamed, red, and accumulate fluid. These changes lead to the symptoms of
pneumonia.
Common symptoms
of pneumonia include fever, a cough that produces green or yellow sputum,
chest pain, a rapid heart and breathing rate, Shaking chills (called
rigors) and a change in mental status (confusion, unclear thinking) can
occur.
Some groups are
at a greater risk of developing pneumonia. These include persons who:
-
Are greater
than 65 years old
-
Are
cigarette smokers
-
Are
malnourished due to health conditions or lack of access to food
-
Have
underlying lung disease, including cystic fibrosis, asthma, chronic
obstructive pulmonary disease, and emphysema
-
Have other
underlying medical problems, including diabetes and heart disease
-
Have a
weakened immune system due to HIV, organ transplant, chemotherapy, or
chronic steroid use
-
Have
difficulty coughing due to stroke, sedating drugs or alcohol, or
limited mobility
-
Have had a
recent viral upper respiratory tract infection
Diagnosis of
pneumonia includes a complete medical history and physical examination, a
chest x-ray, sputum test to identify the bacteria that caused the
pneumonia and help guide antibiotic choice, complete blood cell count (CBC)
and sometimes a blood culture.
The goal of
treatment for patients with CAP is to treat the infection and prevent
complications. Treatment of CAP is usually chosen based upon the common
organisms causing pneumonia. Most patients with CAP can be treated at home
with oral antibiotics. Others, who are at increased risk for
complications, require hospitalisation, close monitoring and intravenous
antibiotics. It is important to finish the entire course of medication and
take it exactly as directed to prevent recurrence with resistant organism
and complications.
The department
of chest medicine follows the international guidelines prescribed for the
treatment of pneumonia and is well equipped to handle such cases with the
back up of the state-of-art intensive care unit (ICU).
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