I am Dr. M.C Gupta. Practicing at Jeevan Jyoti Hospital, Faridabad. I am a pulmonologist and going to talk about asthma.
Asthma is a chronic inflammatory disease of the airways. Leading to hyper responsiveness of the airways, causing breathlessness, chest tightness, cough which is usually in the night or early morning hours. It should be reversible by it self or by drugs. Prevalence of asthma is in India between 1.3 to 2.5% and it is higher in the children and go even up to 10%. Type of asthma are childhood asthma, adult onset asthma, chronic asthma, occupational asthma and difficult to treat asthma. Asthma is usually genetic or environmental factors. The environmental triggers usually are allergens. Most of are, in allergens most important cause is house dust might. It can be due to stress, anxiety, obesity, drugs, infection. Infection are usually viral. It can be due to drugs like aspirin, NSIAD, or ace. The diagnosis of asthma is usually by pulmonary function test which shows the obstruction and the reversibility of the obstruction by inhaled short acting beta to agonist. If the reversibility is good then the patient is labeled as asthma. Treatment of asthma is for emergency patients or a routine patients. If a patient is unable to take proper breath, his heart rate is more than 120, he is having increased respiratory rate of 30 or having sinuses or unable to speak a single sentence then he is having a severe attack of asthma and should be rushed, patient should be rushed to the nearby health faculty for admission and treatment. Treatment for routine asthmatic is divided into certain steps. Steps 1 to 5. In the step 1, the patient is given short acting beta 2 agonist as and when required, with that the patient usually remain all right, the need for inhalation for beta 2 agonist should not be regular. Step 2 consist of inhaled corticosteroids in low doses, and the patient remain usually well controlled with that. In the step 3 of this, there is a either high dose of inhaled corticosteroids or combination of low dosed inhaled corticosteroids plus long acting beta 2 agonist. In step 4 if the patients is not controlled with the drugs in step 3 then, the patient is put on to step 4 and contain high dose inhaled corticosteroids plus long acting beta2 agonist. Most of the patients are controlled up to steep wise treatment 1 to 4. If the patient is not controlled given with that then the patient may need oral corticosteroids or anti iGE treatment.
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I am Dr. MC Gupta, a respective physician practising in Faridabad for the last 40 years. My talk is on Asthma.
Asthma is a very common disease involves 3-10 % of the population and the prevalence is gradually increasing due to increased pollution in the industrialization and environmental and occupational problems. It is characterized by chronic inflammation of the air tubes that carry oxygen and air from and into the lung. Due to chronic inflammation of the air tubes, there is a hyper responsiveness of the air tube that means if there is any trigger they react, constrict, there is an increase inflammation and that lead to the attack of asthma.
Asthma by symptom is characterized by shortness of breath, chest tightness, cough. These are the main three symptoms. Asthma is usually variable. One we have an asthma attack and the patient may go into dimensions when there are no symptoms at all.
There are many risk factors and if we control the risk factor we can avoid or control the asthma attack. The risk factors are a family if any one of the parents is having asthma then there are twenty-five percent chances of children getting asthma or if both the parents are having asthma then fifty percent of children can develop asthma. Other risk factors are repeated viral infections, stress obesity, rhinitis, reflex, some medicines which can aggravate the symptoms of asthma, even in some exercise can induce asthma which is called exercise induced asthma. Tablet aspirin commonly taken as disprin and in some persons can induce the attack of asthma.
The diagnosis very simple usually on the basis of symptoms the patient is suffering supported by pulmonary function tests, x-ray test, haemogram and total IGE and rust test for lse.
Treatment of asthma depends upon the character of asthma, rather it just mild intermittent or it is persistent. In persistent is mild moderate and severe. If the asthma is just mild and intermittent one needs only rescue medicine that shorts acting beta 2 taken during the time of the attack and after that, the patient usually goes into remission and does not require the treatment. In persistent asthma, in mild asthma long acting beta 2 with an inhaled corticosteroid in minimum doses that control asthma and keep under control. Moderate asthma and severe asthma the bowls of inhaled corticosteroid can be increased from 800mg to 2000 microgram and it should be given in a combination of long acting beta 2. In the fourth stage of asthma, these inhaled corticosteroid plus long acting beta 2 agonists may be added with LAMA that is long acting muscarinic acids agents or taken orally or steroids. The oral steroids should not be taken continuously for the treatment of asthma because they can cause osteoporosis diabetes, hypertension and obesity.
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Understanding what causes COPD and what are the signs that a person might be suffering from it.
Clinical diagnosis of COPD is usually made by presence of symptoms that is cough, sputum production, breathlessness and spirometry. Assessment of COPD is also made by spirometry and rate of excess exacerbation. With each exacerbation there is increased breathlessness, increase in the sputum production, increase in cough, there is sputum may be dark in color which shows infection. For each excess exacerbation there is permanent damage of a lung and severity of the COPD may increase.
Treatment of COPD is by pharmacotherapy which aims to control the symptoms of the patient and prevent exacerbation. If you prevent the exacerbation then the patient health improves and prevent further damage to the lungs. If a patient is Breathless on walking at ground level, then the patient may be helped by rehabilitation and by increasing the day to day activities. Exacerbation can be prevented by adult vaccination that is vaccination for non invasive pneumococcal infection and flu vaccination. This disease is gradually progressive. Symptoms can be controlled with pharmacotherapy. But the disease cannot be cured. The main aim of the diseases to prevent and to prevent is hundred percent. If one avoid smoking, exposure to occupational gases and inter Biomass exposure. Patient of COPD should consult a chest physician or respiratory physician.
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Management of Bronchial Asthma
I’m Dr. M. C. Gupta, practicing at Jeevan Jyoti Hospital, Faridabad for the last forty years in pulmonary medicine. Today, I will talk regarding bronchial Asthma. Asthma is prevalent in about 5-10 percent population. Symptoms of asthma are cough, breathlessness, chest, tightness and wheeze. It can occur at any age from an infant to old person. On examination, one may find bronchitis on chest.
The treatment of asthma is, if it is mild and infrequent then, only SABAs that is Short-Acting Beta-Agonists can be taken off and on as and when required. If someone is having persistent asthma then along with inhaled corticosteroids one need LABAs that is Long-Acting Beta-Agonist which is to be continued till the symptoms are controlled. After the symptoms are controlled, one can be put on controller medicine that is inhaled corticosteroids and which should be taken in the minimum possible dose to prevent any side effects of the inhaled steroids. The side effects of inhaled steroids are very less as compared to oral steroids. The treatment may continue lifelong or the patient may go into reminiscence.
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Pleural effusion, in medical terms, is a condition characterized by an abnormal accumulation of fluids in the pleural space. The pleural space is essentially the region between the tissues that form the lining of the lungs and the chest cavity. The fluid that builds up in the pleural space may either be protein-rich (Exudative Pleural Effusions) or watery (Transudative Pleural Effusions) in nature, thus helping doctors ascertain the cause of the pleural effusion.
- Exudative Pleural Effusions are often found to be triggered by medical conditions such as Cancer, Inflammatory diseases, Kidney disorder, Pneumonia, or Pulmonary embolism.
- Transudative Pleural Effusions, on the other hand, may be triggered by Cirrhosis, Heart Attack and Pulmonary embolism. People undergoing an open heart surgery are also susceptible to Transudative Pleural Effusions.
Further, people with Meigs’ syndrome, autoimmune diseases, congestive heart problems, Chylothorax, Ovarian hyperstimulation syndrome, or Tuberculosis also stand a higher risk of suffering from pleural effusions.
In most of the affected individuals, pleural effusions trigger
- Shortness of breath or difficulties in breathing, a condition called Dyspnea.
- Some individuals also experience chest pain, dry cough, and Orthopnea (difficulty in breathing especially while in lying flat or in a sleeping position).
The first step towards effective treatment includes identifying the underlying health problem that triggered pleural effusions. Doctors work towards
- Treating the pleural effusions.
- Ensuring that the condition (Pleural effusions) does not recur.
- Measures are also taken to treat the health problem that resulted in pleural effusions.
In case of severe breathing troubles, doctors may perform Thoracentesis, an invasive procedure whereby the doctor carefully inserts a needle through the chest wall to drain out the excess fluids that have accumulated in the pleural space. While Thoracentesis is known to produce fruitful results, people with chronic lung disorders or a lung surgery should refrain from this procedure.
In the case of pleural effusions resulting from congestive heart failure, the use of diuretics come as a great relief. To prevent the recurrence of the condition or to deal with malignant pleural effusions, doctors may also opt for Pleural sclerosis or Pleurodesis, which involves the removal of excess pleural fluid from the pleural space.
The doctor slightly irritates the tissues of the pleural lining to create a scar. It is this scarring that results in the fusion of the two pleural layers thus filling the space between the layers and preventing the recurrence of pleural effusion. In malignant pleural effusions, patients may also require chemotherapy or radiation therapy. In extreme cases, doctors may perform Video-Assisted Thoracoscopic Surgery (VATS). In VATS, ½ -inch long incisions (1-2) are made to drain out the pleural fluid. To avoid recurrence of the effusion, an antibiotic or a sterile talc is placed inside during the surgery.
In case of pleural effusion resulting in infection at the pleural space, an Open Thoracic Surgery (Thoracotomy) is carried out to treat the condition.
While there are several treatment methods for pleural effusion, proper identification of the underlying cause is imperative to recommend the line of treatment best suited for the patient.