ASTHMA
Asthma is a
syndrome of variable airflow obstruction. It is characterized by bronchial
inflammation with prominent eosinophil infiltration, variable cough, chest
tightness and wheeze.
Classification
1. Extrinsic
asthma
2. Intrinsic
asthma
3. Mixed forms
EXTRINSIC
ASTHMA
CLINICAL FEATURES
Seen in young
persons, child or teenage. Most having history of eczema during their
childhood, and family history of asthma eczema or hay fever. Intermittent
attacks are seen. Attacks are acute but usually self-limiting. Prognosis is
favorable.
INTRINSIC
ASTHMA.
CLINICAL FEATURES.
Seen in the
adult patients over 35 yrs or more. No history of eczema in childhood. Attacks
related to infection, exercise, etc. Attacks are more fulminant and severe.
Prognosis is poor.
Asthmatic attack
1-premonitory
symptoms/asthmatic symptoms/asthmatic aura-
Sneezing,flatulence,drowsiness,restlessness,
and irritability.
Dry irritant
cough may precede or accompany attacks of wheezy breathlessness.
2. Paroxysm:
usually seen in the middle of the night. Sense of oppression in the chest.
Patient sits up and leans forward fighting for breath or runs to the window to
relieve the sense of suffocation. Wheezing heard. Anxiety, cyanosis,
perspiration and cold extremities are seen.
3. Termination:
spontaneously or as a result of therapy. As bronchial spasm gets less, patient can
cough a little and may bring out viscid mucofibrin.
4. Duration of
attack: It varies from few minutes to several hours. Sometimes paroxysms are
continuous -status asthmaticus.
The association
between atopy and asthma suggests that sensitation and exposure by allergens is
an important risk factor. Warm humid centrally heated homes favor the
multiplication of house dust mites. This contributes child hood asthma. The
relationship between exposure to pet and asthma is a little controversial. Some
say pet exposure in early life may offer a protective role against asthma. Milk
fat vitamin E and selenium may protect the child from asthma. However, cow’s
milk protein may develop atopy and asthma.
INVESTIGATION:
1. Chest
radiograph: It may be normal, or show the signs segmental or lobar collapse.
2. Full blood
count: eosinophilia
3. Sputum: eosinophil,
Charcot, and at times Curschmann spirals may appear.
4. Skin tests:
It may confirm allergens suggested by history.
5. Provocation
test (challenge) test: exercise challenge tests useful in young adults and can
be used to confirm the diagnosis of asthma, since fall in FEV1or PEFR occurs
after 5-7 minutes of vigorous exercise.
6. IgE and IgE
specific test
Treatment-
General treatment.
Keep away from
dust, mites and pollen
Avoid blankets
Keep away furry
things like the teddy bear, especially in children
Keep away from
smoke and other atmospheric pollution.
Aim of homeopathic treatment
To cut short the
episodes.
To reduce
intensity and severity.
Complete cure in
children and young adults.
Palliation in
old aged persons.
Homeopathy is
the apt choice for the treatment of asthma. It works wonders in asthma. Both
the acute exacerbation, as well as chronic asthma can be completely curable in
the homeopathic system of treatment.
In acute onset,
the time of aggravations, and other worsening factors, amelioration factors,
and positions, etc. are all taken into consideration.
And the selected
remedy is given in a frequent interval until an improvement is obtained.
Once the acute
episode is controlled then it is time to give a miasmatic remedy that cures
completely in a permanent manner.
For this, a
detailed case taking as per homeopathic philosophy is needed. The mental and
physical built of the patient with his and family histories are needed. The
remedy thus selected is usually tried in medium potency. Since it being a
chronic disease, remedies may change when the symptoms changes. In short, homeopathy
and homeopathic medicine is a ray of hope for asthma. Especially in situations
where the conventional treatments like bronchodilators, inhalers, etc. have got
too many demerits.
Acute cases are
managed by Antimonum tart in different potencies, Ars alb, Amm- carb, Grindelia
Q, SenegaQ, Spongia Q, etc.
Thuja,
Syphyllinum, Bacillinum, kali carb etc. are the main remedies
BRONCHIECTASIS
Bronchiectasis
is a destructive lung disease characterized by chronic dilatation of the
bronchi associated with persistent though a variable inflammatory process in lungs.
Usually acquired, but may result from the underlying genetic or congenital defects
of airway defences.
Pathology
The
diagnostic feature of Bronchiectasis is dilated bronchi.
The
Ried’s classification differentiates between pathological and radiological appearances
of Bronchiectasis.
Cylindrical bronchiectasis
Varicose bronchiectasis
Saccular and cystic bronchiectasis
Atelectatic bronchiectasis
Causes
Congenital-cystic
fibrosis, primary hypogammaglobulinemia
Acquired-in
children-inhaled foreign body, pneumonia complicating from measles, whooping
cough, primary TB
In
adult-pulmonary TB, bronchial tumor, suppurative pneumonia
Clinical features.
1.
Bronchitis: attacks of recurrent bronchitis more common in winter. Clubbing of
finger is diagnostic.
2.
Hemorrhagic or bronchiectasis sicca: recurrent hemoptysis with good health in
between
3.
Suppurative: chronic cough, copious purulent expectoration general toxemia
clubbing of fingers varying from slight beak curvature of finger nails to
bulbous drumstick enlargement
4.
with a relatively rapid onset: symptoms developing with comparative suddenness
as a sequale to partial bronchial obstruction by foreign body or after
anesthesia
Signs
There
may be signs of bronchitis, fibrosis, consolidation, collapse or of cavitations.
Early
stages: fine crackles or sticky rhonchi and slight alteration in character of
breathe sounds.
Late
stages: bronchial breathing, coarse creps and perhaps signs of cavity. Sharp
metallic or leathery rales are characteristic. Recurrent pneumonia in the same
area of the lung is classically associated with bronchiectasis.
Investigation
Culture
and sensitivity of sputum.
Radiology
Sinus
radiographs
Chest
radiography
HRCT: high resolution CT
Special investigation
Immunoglobulin
Barium
studies
Alpha
1 antitrypsin deficiency
Detection
of cystic fibrosis
Homeopathic treatment
Since
it belongs to syco-syphilitic miasm, if not treated with anti miasmatic
remedies the prognosis will not be favorable. And in clinical, it is seen that,
bronchiectasis due to acquired causes responds very well to the homeopathic
treatment. However, if bronchiectasis due to genetic or congenital factors
complete cure is impossible but palliation of the symptoms only.
Moreover,
in the young and adult patients, the prognosis is favorable, but in aged people,
symptomatic relief is the result.
Anyway
overall results are favorable with homeopathic treatment.
Treatment-homeopathic
medicines-Antim tart, Phosphorus, Acalypha indica, etc.
BRONCHITIS
ACUTE BRONCHITIS:
It
is the acute infection of the mucous membrane of trachea and bronchi produced by
viruses and bacteria or external irritants.
Causes
Precipitating
causes
1)Infection - bacterial or viral or
descending infection from nasal sinuses or throat.
2)
Complicating other diseases:e.g.:measles, whooping cough
3)Physical and chemical irritants: inhaled dust,
steam, gases like SO2, ether.
4)Allergic bronchitis following inhalation of
pollen or organic dust.
Symptoms
X
Toxemic: malaise,fever,palpitation,fever,sweating,
etc.
X
Irritative cough with expectoration. At
first scanty viscid sputum later more copious and muco purulent. Substernal pain
or raw sensation behind the sternum.
X
Obstructive: chocked up feeling, paroxysms
of dyspnoea particularly following spells of coughing relieved by expectoration.
Signs
In
early stages few abnormal signs apart from occasional rhonchi. After 2 or, 3
days diffuse bilateral rhonchi often with rales at the bases, prolonged
expiration and then expiratory wheeze.
CHRONIC BRONCHITIS:
A
clinical disorder characterized by productive cough due to excessive mucous secretion
in the bronchial tree not caused by local bronchopulmonary disease, on most of
the days for at least three months during the year for at least two consecutive
years.
Causes
1)
Infection
a)
As a result of acute bronchitis
b)
Infective focus in the upper respiratory tract
c)
Infective focus in lungs.eg:bronchiectasis,fibrosis or tuberculosis
2)
Smoking: particularly of cigarettes
3)
Air pollution: due to industrial fumes and dust.
4)
General illness: which favors infection: obesity, alcoholism and chronic
kidney disease.
Symptoms of bronchitis
1)
Cough: constant paroxysmal cough, worse in winter or on exposure to cold winds
or sudden change of temperature.
2)
Expectoration: variable. It may be little, thin and mucous or thick or frothy,
mucoid and sticky. It may become mucopurulent during attacks of acute
bronchitis in winter.
3)Dyspnoea:
in advanced cases, breathing becomes quick and wheezing present even at rest.
4)
Fever: absent except in acute exacerbation.
5)
Hemoptysis: usually in the form of streaks of blood.
Signs
1)
Build: usually short and stalky
b)Cyanosis:rarely
with clubbing.
c)signs
)signs of air way obstruction: prolonged expiration, pursing of lips during expiration,
contraction of expiratory muscles of respiration, fixation of the scapula by
clamping the arms at the bedside, in drawing of supraclavicular fossa and intercostal
spaces during inspiration and jugular venous distension during expiration due
to excessive swings of intrathoracic pressure.
d)
Wide-spread wheezes of variable pitch usually marked in expiration. Crackles of
lung bases in patients with excessive bronchial secretions. Both wheezing and
crackles may be altered in character by coughing.
Investigations
1)
Ventillatory indices: reduced PEF and VC.
2)
Chest radiography: It may be normal. Infective episodes may produce patchy
shadows of irregular distribution due to pneumonic consolidation, and small
linear fibrotic scar may result.
Homeopathic
treatment.
Since acute bronchitis presents with too many symptoms,
homeopathy has got a better scope in the treatment of acute bronchitis. The
advantage of homeopathic treatment is that the change of acute bronchitis to
chronic bronchitis can be very well prevented.
In chronic bronchitis, especially if it occurs in
old aged people and with a history of smoking complete cure is very difficult.
But symptomatic relief can be given, and thus the quality of life can be
increased.
But in young people if homeopathic treatment is
tried with lifestyle modification definitely complete cure is possible.
Medicines for acute bronchitis
Antim, tart, Ipecac, Ars alb, Grindelia, etc.
Medicines for chronic bronchitis-
Thuja, Ars alb, Tuberculinum, Bacil, Senega,
Aspidosperma, etc.
COR PULMONALE
In
simple term, it can be defined as heart disease secondary to lung disease. Here
the right ventricle of the heart is structurally and functionally damaged due
to the disease of the respiratory system.
Pulmonary
hypertension due to the increased blood pressure in the lungs is the
primary
cause of cor pulmonale. It may be acute or chronic.
Conditions that lead to cor-pulmonale.
1- Chronic
obstructive pulmonary disease (COPD)-chronic bronchitis more common, and
emphysema less common
2- Bronchiectasis
3- Pulmonary
tuberculosis
4- Primary
pulmonary hypertension
5- Multiple
emboli
6- Cystic
fibrosis
7- More
prevalent in smokers
Symptoms
X
Chest pain
X
Wheezing, cough
X
Cyanosis of lips and fingers
Investigations
Blood
examination-polycythemica
Chests
x ray- hilar prominence, with pulmonary artery dilatation.
ECG-Right
Ventricular Hypertrophy, tricuspid valve regurgitation
Treatment-
Complete
cure impossible. However, quality of
life can be markedly improved by homeopathic medicine. The main of homeopathic
treatment is to reduce the use of cortisone and other medicines, and to prevent
further damage to the lung tissues.
The
disease being the result of some irreversible pathology, as per homeopathic
miasmatic theory, it belongs to syphilitic miasm. So back to normalcy is impossible
not only in homeopathy but in any system of medicines. But homeopathy has got
an upper hand in the symptomatic management of COPD, since it safe and free
from unwanted side effects.
In
severe cases along with homeopathic medicines, oxygen supplements is a great
relief for the patient.
EMPHYSEMA
Emphysema
is a component of COPD (chronic
obstructive pulmonary disease) characterized by abnormal,
permanent enlargement of air spaces distal to terminal bronchioles. It is
caused by the combination of mechanical obstruction in the small airways from inflammation
and later scarring, and loss of elastic recoil of the lung which makes these
airways more likely to collapse during expiration.
ANATOMICAL TYPE OF EMPHYSEMA
1.
Centrilobular emphysema
2.
Panacinar or pan lobular emphysema.
3.
Parietal or periacinar emphysema
Bronchiolitis:
comprising infiltration of inflammatory cells, particularly macrophages, into the
bronchiolar wall is one of the earliest lesions in the cigarette smokers. It can produce fibrosis of small airways in
the patient with COPD.
CLINICAL FEATURES
In
predominant emphysema, the patient will be very thin and there will be marked weight
loss. The sputum is very scanty. Dyspnoea is intense with purse lip breathing.
The cough usually starts after dyspnoea. The bronchial infections are less
frequent and episodes of respiratory failure often terminal. Pulmonary
hypertension is none or mild unrelenting downhill. The chest radiograph shows
narrow cardiac shadow, attenuated vessels, and emphysematous bullous changes. The
arterial partial CO2 is normal. The elastic recoil is markedly decreased. Resistance
is normal or slightly increased, and diffusing capacity is increased.
Homeopathic treatment
In emphysema, the outcome is, the lungs fail
to recoil back to its original shape. To happen this it takes many years. So in
well established cases complete cure and make the lung back to normalcy is impossible.
The miasm behind the emphysema is tubercular changes into syphilitic as disease
progress into an established form.
So homeopathic remedies should cover both
this miasm.
But if homeopathic treatment starts in the
early stage and with lifestyle changes marked relief of symptoms is possible,
and the patient can lead almost normal life.
Homeopathic medicines usually prescribed are.
Anti tart, Bacillinum, Tuberculinum, Phos,
Ars alb, Aspidosperma, etc.
www.onlinehomeocure.com
mail@doctorakbarkp.com
RESPIRATORY
DISEASE CAUSED BY FUNGI.
Some fungi infect the human tissues and cause
damage, resulting in allergic reaction or producing toxins.
The disease caused by fungal infection is
called as mycosis.
ASPERGILLOSIS
Bronchopulmonary aspergillosis is caused by
aspergillus fumigatus.
Classification
of Bronchopulmonary aspergillosis
1.
Atopic asthma
2.
Allergic aspergillosis
3.
Extrinsic allergic alveolitis
4.
Intracavitary aspergilloma
5.
Invasive pulmonary aspergillosis
ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS
This
is caused by hypersensitivity reaction to aspergillus fumigatus involving the
bronchial wall and peripheral parts of the lungs.
Clinical features
X
Fever
X
Breathlessness
X
Cough and worsening of asthmatic
symptoms
INTRACAVITARY ASPERGILLOMA
Inhaled
air borne spores of aspergillusfumigatus may lodge and germinate in the damaged
pulmonary tissue, and an aspergilloma can form in any area of damaged lung in
which there is a persistent abnormal space.
Clinical features
X
Recurrent hemoptysis
X
Presence of the fungus ball in the lung
can give rise to features such as lethargy and weight loss.
INVASIVE PULMONARY ASPERGILLOSIS
Invasion
of previously, healthy lung tissue by aspergillus fumigatus is uncommon but can
produce the serious and often fatal condition which usually occurs in patients
who are immuno compromised either by drugs or disease.
Clinical features
X
There will be consolidation, necrosis
and cavitations of the lung.
X
Formation of multiple abscesses is
associated to the production of copious amounts of purulent sputum, which is
often blood stained.
Homeopathic
treatment
Homeopathic medicines are equally effective for
infections, whether it is bacterial, fungal or any other infections. Since the outcome
of infections is plenty of signs and symptoms, the selection of remedy and
accuracy of the selected remedy will have more sharpness.
Homeopathic medicines if selected based on symptomatology
and the patient’s mental and physical characteristics the fungal infection of
lungs can be controlled and further recurrence with can be prevented.
LUNG CANCER
90%
of lung cancers are due to cigarette smoking. The risk fall slowly after the
cessation of smoking. 5% of death due to lung cancer is because of passive
smoking. The incidence is higher for urban areas than in rural areas.
Etiology: Age: 40-50.
SEX: males are more prone
to lung cancer than women.
PREDISPOSING
FACTORS:
1)
Cigarette smoking
2)
Occupational exposure
3)
Atmospheric pollution
4)
Lung disease
CELL
TYPES
a)Squamous-cell carcinoma
b)
Adenocarcinoma
c)Large cell and anaplastic carcinoma
d)Small cell carcinoma
Symptoms
a) Nonspecific symptoms: weakness, loss of
weight, tiredness, anorexia and fever
b) Respiratory symptoms like-
1) Cough: affect majority of patients and is
often associated with influenza like illness.
Pneumonia
distal to the obstruction may be caused by a tumor. Increasing persistence of
cough is the most common symptom.
Recurrent
pneumonia in the same site or pneumonia which is slow to respond to treatment
in smokers is an indicator to bronchial carcinoma.
2)
Hemoptysis:It is usually a common symptom, especially in tumors arising in the
central bronchi. On the other hand, repeated episode of spitting of scanty
blood, or blood streaked sputum in a smoker should raise the suspicion of
bronchial carcinoma.
3)
Dyspnoea: It is usually associated with increased cough and sputum.
4)
Chest pain
METASTATIC SYMPTOMS
A-Intrathoracic
organ affected are-
Phrenic nerve,
recurrent laryngeal nerve, cervical sympathetic, vagus, brachial Plexus and
intercostal nerve are affected.
Esophagus:dysphagia
Vessels:
superior venacava, azygous vein, thoracic duct and axillary vessels
Erosion
of ribs: local pain and bony tenderness
Invasion
of heart and pericardium
B-Extrathoracic
metastasis:
Intracranial
Bony
metastasis
Hepatic
metastasis
Supra
renal metastasis
SYMPTOMS DUE TO NON
METASTATIC/EXTRAPULMONARY MANIFESTATION:
Endocrine
and metabolic
Skeletal
symptoms
Skin
symptoms
Neurological
symptoms
Renal
symptoms
Muscular
symptoms
Vascular
symptom
Hematological
Signs
a)
Fingerclubbing
b)
Palpable supraclavicular nodes
c)
Mid inspiratory crackles
d)
Wheeze
e)
Pleural effusion
Homeopathic treatment-
Good prognosis with homeopathic treatment.
Homeopathic medicine can be given along with conventional medications or
homeopathic medicines alone.
In terminal stages homeopathic medicines act,
act as a good palliative and homeopathic medicine can improve the quality of
life.
Mantoux test
and its significance
Earlier
Mantoux test was considered as the specific diagnostic test for tuberculosis. However,
the co-existence of another disease, age, and immunological status has made the
result controversial.
Five
units of tuberculin (TU- 0. 1 ML) is injected into the left forearm under the skin,
and the result is interpreted as a period 48 to 72 hours. If the injection is
correctly done there should be a pale red elevation of 6 to 10 millimeter in
diameter. The presence or absence of induration is the basis to determine whether
the test is positive or negative. The induration should be determined by
inspection in side view and palpation.
The
test determines the hypersensitivity to tuberculin. The size of induration has
nothing to do with the current active tuberculosis. But the positive reaction
can be interpreted as the future risk of developing TB.
X
The test is read as positive if the
induration is 5 mm or above.
X
False-positive reaction is seen in cases
of previous vaccination with BCG.
X
False-negative reaction is seen in viral infections such as
measles and chicken pox.
X
Recent live vaccination, e.g.; measles
X
Very old as well as recent TB infection
PNEUMONIA
Pneumonia
is the accumulation of secretions and inflammatory cells in the alveolar spaces
within the lungs caused by infection. The infecting organism, the inflammatory
response and the disturbances of gas exchange caused by alveolar involvement
are responsible for the clinical manifestations.
Pneumonia
can be classified as community acquired, nosocomial (hospital acquired), or
pneumonia in patients with underlying damaged lung, or in immunocompromised
patients.
Community-acquired
pneumonia spread by droplet infection.
Nosocomial
pneumonia or hospital-acquired pneumonia is the pneumonia occurring in patients
at least two days after admission to the hospital.
Factors
predispose to pneumonia.
X
Cigarette smoking
X
Old age
X
Alcohol
X
Upper respiratory infection
X
Preexisting lung disease
X
Recent influenza infection
Causes
1) Bacterial- streptococcus pneumonia, microplasma pneumonia,
chlamydia pneumonia, gram-negative pathogens
and Staphylococcus aureus
2) Primary atypical:
a) Viral: psittacosis, respiratory Syncytial
virus, measles and influenza, cytomegalovirus, herpes zoster, adenovirus
b)
Rickettsial -Coxiella burnetti
c)
Mycoplasmal- mycoplasma pneumoniae
3) Protozoa-entameoba histolytica
4) Yeast and fungi- actinomycosis, aspergillosis,
nocardiosis, histoplasmosis
5) Chemical pneumonias
a) Aspiration of vomit
b) Dysphagic pneumonia caused by pharyngeal
diverticulum, achlasia cardia or hiatus hernia
c) Lipoid pneumonia: kerosene, paraffin,
petroleum.
d) Toxic gases and smokes:
6) Radiation pneumonia
BASED ON THE ANATOMICAL PART OF THE LUNG PARENCHYMA
INVOLVED.
Pneumonia
can be classified as.
1)LOBAR
PNEUMONIA: It occurs due to acute bacterial infection of a part of a lobe or
complete lobe.
2)BRONCHO PNEUMONIA:acute
bacterial infection of terminal bronchioles.
3)INTERSTITIAL
PNEUMONIA:this is mainly confined to the interstitial tissue within the lung.
CLINICAL FEATURES:
SYMPTOMS:
General
symptoms:
X
Malaise
X
Fever, rigors
X
Night sweats
X
Vomiting
In
the elderly, confusion and disorientation.
Pulmonary
symptoms:
X
Dyspnoea
X
Cough and sputum which is often blood
stained and rusty and difficult to expectorate.
Pleural
symptoms:
X
Pain aggravated by cough deep breath or movement
Usually localized tothe site of inflammation.
SIGNS:
General: patient appears
ill with tachycardia, rapid respiratory rate, high fever, dry skin, herpes
labialis, confusion, and hypotension.
Pulmonary:
a)Early
signs:slight impairment of the percussion knots over the affected area, with
weakness of breath sounds or possibly harshness with prolonged expiration and
fine crackles on deep inspiration or after cough.
b)Signs
of consolidation on 2nd or 3rd day
c)Resolution:most
signs disappear by the end of 2nd week. But fine crackles and impairment of the
percussion notes may be found longer.
INVESTIGATION
Routine
investigation:
A- blood test-
a)
White cell count marginally raised or may even be normal.
b)
Neutrophil leucocytosis in bacterial etiology
c)
C-reactive protein-CRP – typically elevated
B-Sputum culture
C-Blood culture
D-Chest x-ray
E-Microbiological investigations
Homeopathic remedies for pneumonia-
Antim ars, veratrum viride, Phos,
Pulsatilla, Antimtart,etc.
PULMONARY FUNCTION TEST
PFT
detects the impairment and assesses the effect of treatment and progress in the
disease. It is done to assess the lung capacity, and it determines how quickly
the lung can move air in and out. Spirometry is the common lung function test.
In
respiratory function test, lung volume, gas exchange capacity and airway,
narrowing is quantified and compared with normal values adjusted for age and
gender. The most convenient home monitor test is peak flow meter, but values
are an effort dependent.
Abbreviations
used in PFT.
X
FEV1
forced expiratory volume in 1 second
X
FVC
forced vital capacity.
X
VC
vital capacity
X
PEF
peak expiratory flow.
X
TLC
total lung capacity
X
FRC
functional residual capacity
X
RV
residual volume
X
TLCO Gas transfer factor for carbon
monoxide
X
DLCO
diffusing capacity for carbon monoxide
X
KCO
transfer coefficient for carbon monoxide
Measurement
of gas transfer factor.
The
gas transfer factor may be thought of as the conductance of the lungs for the
gas being studied. It forms the useful overall estimate if the ability of the
lungs to exchange gases and is of particular value in interstitial lung disease,
sarcoidosis and emphysema. It is normally estimated by measuring the uptake of carbon
monoxide from a single breath of a 0.3% mixture in air.
Arterial
blood gas analysis
Modern
automatic analysers give a rapid direct read out of PaO2(Partial pressure of
arterial oxygen) , PaCO2( Partial pressure of carbon dioxide in the blood) and H ion concentration in arterial blood,
often supplemented by derived variables, which may be of value in assessment of
hypoxemia or acid base balances, which may be of value in assessment of hypoxemia.
|
PATTERNS
OF ABNORMAL VENTILATORY CAPACITY TEST |
OBSTRUCTIVE |
RESTICTIVE |
|
FEV1 |
DECRESED |
DECREASED |
|
VC |
DECREASED/NORMAL |
DECREASED |
|
FEV1/VC |
DECREASED |
NORMAL/INCREASED |
RESPIRATORY FAILURE
What is a respiratory failure?
When
the pulmonary gas exchange fails to keep normal arterial oxygen and carbon
dioxide level respiratory failure results.
-Respiratory
failure can be defined in two ways.
Type
1-Failure of oxygenation resulting in PaO2 lesser than 8. 0 KPa
Type
2 -Failure of ventilation resulting in PaCO2 greater than 7.7 KPa with
accompanying acid base changes.
The
basis of classification is the absence or presence of hypercapnia.
CAUSES OF RESPIRATORY FAILURE
1. Airway obstruction:
Upper
airway- obstructive sleep apnoea, trauma, angio oedema, foreign body inhaling
Lower airway- Chronic Obstructive
Pulmonary Disease (COPD), asthma, cystic fibrosis
2. Disorders of lung parenchyma:
Acute
Acute
respiratory distress syndrome.
It
includes the following conditions
A-Pneumonia.
B-Acute
pulmonary edema
C-Acute
pulmonary embolism.
Chronic
It
may be due to-
a-Chronic
fibrosing alveolitis
b-Pneumoconiosis
c-Sarcoidosis
3. Disorders of the respiratory muscle
pump
Neurological
Examples are -Brain stem disease,
over sedation, central sleep apnoea, and cervical cord trauma.
Musculoskeletal
Examples are scoliosis, chest wall trauma,
muscular dystrophy.
Clinical features
X
Due to hypoxemia:
Patient
becomes restless, mental confusion, sweating, tachycardia, and central
cyanosis, depressed level of consciousness, poor peripheral circulation, and
cardiac arrhythmias.
X
Due to hypercapnia:
Breathlessness,
headache, warm extremities, bounding pulse, muscle twitching, elevated blood
pressure, papilledema occasionally, cardiac
dysrhythmias.
Effects
on CNS functions -such as asterixis, hyperreflexia, miosis, confusion and coma.
TUBERCULOSIS
Tuberculosis was
under control until recently. However, due to the emergence of drug resistant and
new strain bacteria it is again becoming a challenge to the health authorities.
Pulmonary
tuberculosis
This
is a disease of lung, pleurae or mediastinal lymph nodes caused by Mycobacterium
tuberculosis. This disease is seen in all age groups but highly susceptible to
three years of age.
They
are most common in poor communities due to poverty, poor sanitation, housing
state, nutrition and overcrowding,etc.;And also seen in people who are addicted
to tobacco, alcohol, etc.
The
causative organism of tuberculosis includes two species M.tuberculosis and M.bovis.
TYPES
1)
Primary tuberculosis
2)
Post primary tuberculosis.
Primary
tuberculosis
The primary infection usually occurs
in childhood and in the majority of patients, the primary infection produces no
symptoms or signs and passes unnoticed until routine radiological examination
of the chest happens to be performed at the appropriate time.
Clinical features
1)
Asymptomatic type
This
is the commonest type and Ghon's focus in the X-ray and positive Mantoux test is
the evidence of past infection.
2)
Febrile type
Fever
ranging from 37.5 - 39.5 c -lasting
for 1 to 2 weeks.
3)
Allergic type
The
patient shows erythema nodosum, or phlyctenular keratitis, conjunctivitis or both.
4)
Progressive type
Patient
may develop tuberculosis pneumonia, bronchopneumonia, pleurisy, pleural
effusion. Military tuberculosis, and tuberculosis meningitis,
lobar or segmental collapse.
POST PRIMARY TUBERCULOSIS
The
onset of post primary tuberculosis is usually insidious, with gradual
development.
General
symptoms are cough and sputum. The lesions are most frequently situated in the
upper lobes. Sometimes the dramatic event like hemoptysis, pleural pain or
spontaneous pneumothorax marks the onset. The earliest physical sign includes
few crepitations, physical signs of consolidation, cavitations and
fibrosis.
INVESTIGATIONS
1)
Mantoux test shows a positive reaction.
2)
Sputum examination
3)
X RAY -chest (PA) may show enlarged hilar nodes with sub pleural lesion.
4)
ESR (Erythrocyte Sedimentation Rate) is raised.
Homeopathic
treatment-
From my clinical experience, it is found that
instead of trying homeopathic medicines alone, a combined therapy is highly
effective.