Coughing is a common problem of the respiratory tract and often indicates a deeper problem. It can be very irritating and can affect eating habits and socialization. A cough which persists for more than 4 weeks is believed to be chronic in nature. Tuberculosis (TB) is the most common cause of chronic cough in India. TB is an airborne bacterial infection caused by the organism - 'Mycobacterium tuberculosis', that primarily affects the lungs, although other organs and tissues may be involved. Cardinal features are: 

Chronic cough with or without sputum.
Fever more in the night time. 
Poor appetite. 
Unintentional weight loss. 
Read on to know about other common causes of chronic cough and how to manage them.

Allergies: People with allergies usually have a chronic cough, which gets aggravated when exposed to the allergens such as pollen or environmental dust. Staying away from allergen provides relief. Antihistamines are also useful, which most people detected with allergies keep in handy. Inhalers might be required, if there is associated congestion or shortness of breath.
Asthma: This is a very common chronic condition, caused by inflammation and swelling of the lungs, in addition to wheezing and shortness of breath. Asthma patients often suffer from a chronic cough. An asthma attack usually happens during the night or early morning, and is triggered by colds, cigarette smoke, air pollutants or allergens, which can even include certain foods. Most asthmatics usually carry their steroids, inhalers, and bronchodilators, as the onset of attack can be unpredictable.
Bronchitis: This condition of inflammation of the bronchial region is very common among smokers and among the elderly. There is excessive mucus accumulation, which the body tries to clear via coughing. The lungs are weakened and therefore, the coughing is painful.
Gastroesophageal reflux disease (GERD): This is a problem of the digestive system, but regurgitation of food into the airway induces cough. GERD is a chronic issue and so most people also end up with a chronic cough. It is worse with sitting up than with sitting down. Treatment includes H2 blockers to suppress acid production and dietary changes including small, frequent meals and avoiding spicy food items.
Upper airway cough syndrome: There could be multiple problems in the upper airway, which leads to a constant postnasal drip. Here, there is constant dripping of the sputum into the air passage, which can lead to a chronic cough whenever there is impaired air flow. This can be caused by various forms of chronic sinusitis and rhinitis. People diagnosed with this condition usually resort to antihistamines and decongestants for relief.
Other causes: There are a number of other causes as noted below. Smoking, tuberculosis, congestive heart failure, pertussis or whooping cough, foreign body in the airway, cancer in the airway passage, chronic aspiration of foods, etc. can all lead to chronic cough.
The key is to identify the reason that is causing the chronic cough. Most people who are diagnosed are educated to handle it and carry the required medications including steroids, bronchodilators, and inhalers.

Suffering from Chronic Cough - How to Manage it?

Arrhythmia is a disorder which is characterized by improper and irregular heartbeats; be it too slow or too fast. This problem occurs when the electrical impulses that are used to regulate your heartbeat don t work in the correct manner. Your heart may beat irregularly, too slow or too fast.

Symptoms
Although this disorder does not yield many symptoms, a few noticeable symptoms of arrhythmia are slow heartbeat, or a racing heartbeat, chest pain, breathing difficulties and dizziness. Arrhythmia can lead to inefficient pumping by the heart, leading to bouts of fainting. A severe symptom of this disorder is ventricular fibrillation, wherein the ventricles tend to quiver instead of transporting blood. This symptom can cut off blood supply to the vital organs, which may lead to death.

Causes

Coronary artery disease: In this disease, arteries of the heart can get blocked, leading to irregular heart beat and impaired heart functioning.
A heart attack: An ongoing heart attack usually leads to irregular heartbeats.
High blood pressure: High blood pressure problems make you more vulnerable to this condition.
Impaired functioning of the thyroid glands: An overactive or underactive thyroid gland can lead to heart arrhythmia.
Excessive smoking and alcohol consumption: These habits can cause problems with the blood vessels in the body, thus increasing risks of this particular condition as well as other cardio-vascular diseases.
Stress: Too much stress can lead to high blood pressure; that is again linked to heart arrhythmia.
Treatment
Mild symptoms of arrhythmia do not require treatment. However, complications resulting from it warrant treatment. The various treatment options for this condition are:

Pacemaker: A pacemaker is a device that is used to regulate your heart rhythms. It is placed in the body by a surgical procedure and an insulated wire is put, connecting the heart to the pacemaker. In case of an irregular heartbeat, the pacemaker sends out impulses to correct the improper heartbeat.
Implantable cardioverter-defibrillator: This device is used to prevent a dangerous symptom of heart arrhythmia, a symptom wherein the ventricle quivers. It is similar to a pacemaker as it is also placed near the collarbone. In case it detects an abnormal rhythm, it sends out shocks to reset the heart rhythm.
Maze procedure: This is a surgical procedure wherein incisions are made on the upper heart tissue to create a scar tissue. Scar tissues act as insulators to prevent stray impulses.
Alternative therapies: Alternative procedures such as yoga and meditation can help remedy the disorder.

Is Your Heart Missing a Beat Regularly - Could it be Arrhythmia?

How to diagnose asthma in children

Asthma in children under the age of 5 is a matter of concern. It is not a rare disease and early diagnosis is important. Common signs of asthma in children are:

1. Recurring bronchitis
2. Wheezing
3. Discomfort in the chest
4. Coughing
5. Trouble breathing

While some children have persistent yet mild symptoms, some children have severe attacks at times. Seasonal allergies and smoke make the symptoms worse.

What to notice?
While feeding an infant, if you notice that your child is facing shortness of breath, it might be a symptom of asthma. In a toddler, if your notice a decreased desire to run and play, or easy fatigue, then this could be a symptom of asthma. Asthma attacks for many children under the age of 5 are worsened when they catch cold or have any other respiratory infections. All these, if noticed should not be ignored and your child's pediatrician should be consulted.

The above mentioned symptoms were mild. Some children have it worse and the attacks can be life-threatening, needing immediate treatment. If your child is under the age of 5 and you see them doing one of the following, contact emergency services immediately:

1. Trouble in speaking because they have restricted breathing
2. When they are breathing in, the effort is so much that the abdomen is getting sucked in
3. Gasping for air.

Diagnosing asthma in a child can be tricky as symptoms like coughing, wheezing, etc can be for other conditions also. Once a child is a little older and if the symptoms persist, breathing and lung function tests are taken to gauge the situation. 

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How To Diagnose Asthma In Children, Before It Attacks?

The inflammation of the tissues around the sinuses is a condition known as sinusitis. This can be triggered by a number of factors including a common cold and pollen allergies. The symptoms of acute sinusitis are

Facial muscle pain
Stuffiness of the nose
Running nose
Congestion
Loss of smell

Sinusitis is an uncomfortable condition on its own, but can also lead to a number of other complications. Ayurveda can be very effective in treating sinusitis without causing any other side effects. Here are a few ways to treat sinusitis with Ayurveda.

Steam inhalations

Steam is a decongestant that can successfully clear congestion and make sinusitis less painful. This can be done five to six times a day. If your sinus is causing excessive pain, this should be repeated regularly for at least a week. In cases of chronic sinusitis, you may even continue this form of treatment for two years.

Nasyam

Nasyam is one of the five therapies of detoxification according to Ayurveda. It treats sinusitis by administering medicated oils or herbal juices through the nostrils into the body. Nasyam acts by attacking and removing excess humor in sinus cavities. This improves the flow of oxygen in the body, and thus also helps treat the pain that is a result of your sinusitis.

Ginger-Garlic

Ginger and garlic have a number of medicinal properties. A teaspoon of fresh ginger juice with honey can help reduce the congestion caused by sinusitis. This should ideally be had early in the morning, as soon as you wake up and may be repeated in the evening. Similarly, create a concoction with crushed garlic, turmeric, and honey, in the ratio of 1 tsp each of garlic and turmeric and 2 tbsp of honey. Have 1 tsp of this concoction daily.

Jala Neti

Neti is a yogic purification method and jala neti refers to purification by water. This is a simple technique that should be practiced daily to relieve problems related to sinuses. Fill a neti pot with lukewarm water and a little salt. Position the neti pot such that the spout is in one of the nostrils. Breathe through your mouth and tilt your head till the water starts flowing from one nostril to the other. Once the pot has been emptied, repeat the process with another nostril. This can be repeated any number of times.

Change your diet

Ayurveda is a lifestyle and hence diet is a very important part of the treatment. Avoid cold and oily food. Starting the day with a glass of lemon juice and water is also said to be beneficial to sinusitis patients. Processed foods, chocolates, liquor, carbonated drinks etc are other things to be refrained from when treating sinusitis with Ayurveda.

Treating Sinusitis with Ayurveda

Tuberculosis is an opportunistic infection caused by the bacteria Mycobacterium tuberculosis. The infections occurring in people with weak immunity as compared to the people with a healthy immune system are called as opportunistic infections. As, HIV enters the human body, it replicates and weakens the immune system which in turn increases the risk of contracting Tuberculosis in people already suffering from HIV infection.

An HIV and Tuberculosis co-infection occurs when an individual has both, the HIV infection and an either latent or active TB disease simultaneously.  Each disease acts in speeding up the progress of the other, when HIV and TB infection is present together in the body. HIV infection speeds up the progression from latent to active Tuberculosis, Mycobacterium tuberculosis also accelerates the progression of replication and spread of the HIV infection.

HIV infection and Tuberculosis are totally different type of infectious diseases. HIV is a viral infection and TB is a bacterial one. An HIV infected person will not contract TB unless a contact happens with a TB infected person. TB spreads via droplet infection and is communicable. If a person lives in a country with a high prevalence rate of TB, an HIV patient is highly susceptible to contracting the infection. In the similar manner, a person suffering from TB gets infected with the HIV infection only through the blood and bodily fluids borne route, with unprotected sexual intercourse with an HIV infected individual being the most important cause.

Amongst all the other opportunistic infections, TB occurs at an earlier stage in the course of an HIV infection than most other opportunistic infections. Mortality rate in the co-infected patients is more than twice that of HIV infected individuals without a TB infection. Even if a patient is undergoing anti-retroviral therapy, the death rates remain high in co-infected individuals.The natural history and course of TB gets altered in people with an infected immune system. The damage to immunity due to HIV infection causes a drastic reduction in the pathogen killing capacity of the body. In such patients if there is no anti-retroviral treatment prescribed, then the latency period between the infection and progression of disease gets eliminated. 

An active phase of TB is observed in such individuals progressing within a short span of time, ranging from weeks to months, rather than years as it normally should be spanning. Risk of progression from a latent stage to an active stage of TB is around 10-15 times greater in an HIV infected individual as compared to the non-infected person. Such individuals also communicate the disease more rapidly to others.Pulmonary tuberculosis in an HIV infected person can present similar symptoms like that of a classic TB disease. However, a co-infection can sometimes show less presenting TB symptoms, where even the chest X-ray scans can be observed to be normal. A  subclinical  phase of Tb in co-infected patients can cause delay in the diagnosis of the symptoms and subsequently affect the prognosis due to lack of timely treatment.

Social stigma and discrimination has caused an obstacle in provision of adequate treatment for people with HIV. Proper counseling  and initiatives taken to provide indiscriminate care can aid in identification of co-infection and earlier stages. Anti-retroviral treatment teamed up with anti-tubercular drug regimen is prescribed and a successful treatment for drug sensitive cases of TB can be provided with medications for 6-8 months.

How HIV & TB  Are Related?

Chronic obstructive pulmonary disease is a long-term condition of the lungs where the flow of air to the lungs is restricted (obstructed). Symptoms include cough and breathlessness. The condition is most often caused by smoking and the most important treatment is to stop smoking. Inhalers are commonly used to ease symptoms. Other treatments such as steroids, antibiotics, oxygen, and mucus-thinning (mucolytic) medicines are sometimes prescribed in more severe cases, or during a flare-up (exacerbation) of symptoms.

What causes COPD?
Smoking is by far the biggest risk factor for COPD. The lining of the airways becomes inflamed and damaged by smoking. Cigarette smoking is the biggest risk factor.

Air pollution may cause some cases of COPD, or make the disease worse. Air pollution can be indoor air pollution or outdoor air pollution. Indoor air pollution seems to be involved in more cases of COPD than outdoor air pollution. Indoor air pollution includes fumes from indoor fires or stoves, and dust, fumes or chemicals present in some workplaces. The combined effect of exposure at work to air pollutants and smoking increases the chances of developing COPD.

A small number of people have a hereditary (genetic) risk of COPD due to very rare protein deficiencies that can lead to lung, liver and blood disorders. (The condition is called alpha 1 antitrypsin deficiency. Less than 1 in 100 cases of COPD are due to this.


COPD symptoms-


Cough is usually the first symptom to develop. It is produced with phlegm (sputum). It tends to come and go at first, and then gradually becomes more persistent (chronic). You may think of your cough as a 'smokers cough' in the early stages of the disease. It is when the breathlessness begins that people often become concerned.
Breathlessness (shortness of breath) and wheeze may occur only when you exert yourself at first. For example, when you climb the stairs. These symptoms tend to become gradually worse over the years if you continue to smoke. Difficulty with breathing may eventually become quite distressing.

Sputum - the damaged airways make a lot more mucus than normal. This forms sputum. You tend to cough up a lot of sputum each day.

Chest infections are more common if you have COPD. A sudden worsening of symptoms (such as when you have an infection) is called an exacerbation. Wheezing with cough and breathlessness may become worse than usual if you have a chest infection and you may cough more sputum. Sputum usually turns yellow or green during a chest infection. Chest infections can be caused by germs called bacteria or viruses. 
Other symptoms of COPD can be vaguer. Examples are weight loss, tiredness and ankle swelling.

What is the difference between COPD and asthma?


COPD and asthma cause similar symptoms - in particular difficulty breathing (breathlessness). However, they are completely different diseases. Briefly:

In COPD there is permanent damage to the airways. The narrowed airways are fixed, and so symptoms are persistent (chronic). Treatment to open up the airways is therefore limited.

In asthma, there is inflammation in the airways which makes the muscles in the airways narrow (constrict). This is temporary so the narrowing comes and goes. So, the symptoms tend to come and go, and vary in severity from time to time. Treatment to reduce inflammation and to open up the airways usually works well.

COPD is more likely than asthma to cause an ongoing cough with phlegm (sputum).

Waking at night with breathlessness or wheeze is common in asthma and uncommon in COPD.

COPD is rare before the age of 35, whilst asthma is common in under-35s.

There is more likely to be a history of asthma, allergies, eczema and hay fever (so-called atopy) in people with asthma.

Do I need any tests?

The most common test used in helping to diagnose the condition is called spirometry. This is a breathing test. You will be asked to breathe or blow into a small machine called a spirometer which will measure how well your lungs are working. This test can help make a diagnosis of COPD.


A chest X-Ray show signs of COPD and can be used to help exclude other serious conditions (including lung cancer). Occasionally, a special CT scan of the chest - high-resolution CT - is needed. A blood test to make sure you are not anemic is often helpful.

A pulse oximeter is a device which can be clipped on to your finger. It measures your heart rate (pulse) and the amount of oxygen in your circulation (oxygen saturation). Lower levels than normal tend to be found in people who have COPD, especially if you have a flare-up (exacerbation) of your symptoms.

COPD treatment-

Smoking cessation is the most important step towards treatment.
Inhalers

The main treatments are medications given in devices called inhalers. The medicine within the inhaler is in a powdered form which you breathe in (inhale). The medicines in standard inhalers reach the lungs better if used with a spacer device. Inhalers include one, two or even three types of medicines. They may include:


A bronchodilator agent - this is a medicine which opens up (dilates) the airways. Some work quickly but don't last very long; others are longer-acting.
A steroid - these reduce the inflammation in the airway, thereby reducing the swelling. This, in turn, adds to the space available for air to pass.
A medicine which helps to dry up the secretions produced by the airways.
Home oxygen
This may help some people with severe symptoms or end-stage COPD. It does not help in all cases. Unfortunately, just because you feel breathless with COPD it does not mean that oxygen will help you. Great care has to be taken with oxygen therapy. Too much oxygen can actually be harmful if you have COPD.
Regular follow up in OPD is an essential part of treatment success.

Chronic Obstructive Pulmonary Disease - Know More About It!

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