Lower/Upper Respiratory Tract Infection Treatment
Asthma Treatment & Management
Asthma Management Program
Management of Smoking Cessation
Obstructive Sleep Apnea Treatment
Treatment of Sleep Disturbance
Oxygen Therapy Treatment
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Sinusitis: Management and Prevention
Sinusitis is infl ammation of the mucous membranes lining one or more of the paranasal sinuses. The various presentations are as folllows:
● acute sinusitis: infection lasting less than 30 days, with complete resolution of symptoms
● subacute infection: lasts from 30 to 90 days, with complete resolution of symptoms
● recurrent acute infection: episodes of acute infection lasting less than 30 days, with resolution of symptoms, which
Recur at intervals of at least 10 days apart
● chronic sinusitis: infl ammation lasting more than 90 days, with persistent upper respiratory symptoms
● acute bacterial sinusitis superimposed on chronic sinusitis:
New symptoms that occur in patients with residual symptoms from prior infection (s). With treatment, the new symptoms resolve but the residual ones do not.
Physical findings and clinical presentation
● patients often give a history of a recent upper respiratory illness with some improvement, then a relapse.
● mucopurulent secretions in the nasal passage
● purulent nasal and postnasal discharge lasting more than 7 to 10 days
● facial tightness, pressure, or pain
● nasal obstruction
● decreased sense of smell
● purulent pharyngeal secretions, brought up with cough, often worse at night
● erythema, swelling, and tenderness over the infected sinus in a small proportion of patients
● diagnosis cannot be excluded by the absence of such findings.
● these fi ndings are not common, and do not correlate with number of positive sinus aspirates.
● intermittent low-grade fever in about one half of adults with acute bacterial sinusitis
● toothache is a common complaint when the maxillary sinus is involved.
● periorbital cellulitis and excessive tearing with ethmoid sinusitis
● orbital extension of infection: chemosis, proptosis, impaired extraocular movements.
Characteristics of acute sinusitis in children with upper respiratory tract infections:
● persistence of symptoms
● bad breath
● symptoms of chronic sinusitis (may or may not be present)
● nasal or postnasal discharge
● facial pain or pressure
● nosocomial sinusitis is typically seen in patients with nasogastric tubes or nasotracheal intubation.
● each of the four paranasal sinuses is connected to the nasal cavity by narrow tubes (ostia), 1 to 3 mm in diameter; these drain directly into the nose through the turbinates. The sinuses are lined with a ciliated mucous membrane (mucoperiosteum).
● acute viral infection
● infection with the common cold or infl uenza
● mucosal edema and sinus infl ammation
● decreased drainage of thick secretions, obstruction of the sinus ostia
● subsequent entrapment of bacteria
A. Multiplication of bacteria
B. Secondary bacterial infection
Other predisposing factors
● foreign bodies
● congenital choanal atresia
● other entities that cause obstruction of sinus drainage
● dental infections lead to maxillary sinusitis.
● viruses recovered alone or in combination with bacteria (in 16% of cases):
● parainfluenza virus
● respiratory syncytial virus
● the principal bacterial pathogens in sinusitis are streptococcus pneumoniae, nontypeable haemophilus influenzae, and moraxella catarrhalis.
● in the remainder of cases, fi ndings include streptococcus pyogenes, staphylococcus aureus, alpha-hemolytic streptococci, and mixed anaerobic infections (peptostreptococcus, fusobacterium, bacteroides, prevotella).
Infection is polymicrobial in about one third of cases.
● anaerobic infections seen more often in cases of chronic sinusitis and in cases associated with dental infection; anaerobes are unlikely pathogens in sinusitis in children.
● fungal pathogens are isolated with increasing frequency in immunocompromised patients but remain uncommon
Pathogens in the paranasal sinuses. Fungal pathogens include aspergillus, pseudallescheria, sporothrix, phaeohyphomycoses, zygomycetes.
● nosocomial infections occur in patients with nasogastric tubes, nasotracheal intubation, cystic fi brosis, or those who are immunocompromised.
● s. Aureus
● pseudomonas aeruginosa
● klebsiella pneumoniae
● enterobacter spp.
● proteus mirabilis
Organisms typically isolated in chronic sinusitis:
● s. Aureus
● s. Pneumoniae
● h. Infl uenzae
● p. Aeruginosa
● migraine headache
● cluster headache
● dental infection
● trigeminal neuralgia
● water’s projection: sinus radiograph
● ct scan
● much more sensitive than plain radiographs in detecting acute changes and disease in the sinuses
● recommended for patients requiring surgical intervention, including sinus aspiration; it is a useful adjunct to
● used for diagnosis of frontal and maxillary sinusitis
● place transilluminator in the mouth or against cheek to assess maxillary sinuses, and under the medial aspect of the supraorbital ridge to assess frontal sinuses.
● absence of light transmission indicates that sinus is filled with fluid.
● dullness (decreased light transmission) is less helpful in diagnosing infection.
● used to visualize secretions coming from the ostia of infected sinuses
● culture collection via endoscopy often contaminated by nasal flora; not nearly as good as sinus puncture
● sinus puncture
● gold standard for collecting sinus cultures
● generally reserved for treatment failures, suspected intracranial extension, nosocomial sinusitis.
Treatment Nonpharmacologic therapy
● sinus drainage
● nasal vasoconstrictors, such as phenylephrine nose drops, 0.25% or 0.5%
● topical decongestants should not be used for more than a few days because of the risk of rebound congestion.
● systemic decongestants
● nasal or systemic corticosteroids, such as nasal beclomethasone, short-course oral prednisone
● nasal irrigation, with hypertonic or normal saline (saline may act as a mild vasoconstrictor of nasal blood fl ow)
● use of antihistamines has no proved benefi t, and the drying effect on the mucous membranes may cause crusting,
Which blocks the ostia, thus interfering with sinus drainage.
● analgesics, antipyretics.
● most cases of acute sinusitis have a viral cause and will resolve within 2 weeks without antibiotics.
● current treatment recommendations favor symptomatic treatment for those with mild symptoms.
● antibiotics should be reserved for those with moderate to severe symptoms who meet the criteria for diagnosis of
● antibiotic therapy is usually empirical, targeting the common pathogens.
● first-line antibiotics include amoxicillin, tmp-smz.
● second-line antibiotics include clarithromycin, azithromycin, amoxicillin-clavulanate, cefuroxime axetil, loracarbef, ciprofloxacin, levofloxacin.
● for patients with uncomplicated acute sinusitis, the less expensive first-line agents appear to be as effective as the
Costlier second-line agents.
● surgical drainage indicated
● if intracranial or orbital complications suspected
● for many cases of frontal and sphenoid sinusitis
● for chronic sinusitis recalcitrant to medical therapy
● surgical débridement imperative for treatment of fungal sinusitis
Interstitial lung disease is an umbrella term for numerous lung diseases that are caused due to scarring or inflammation of lungs. Because of the inflammation, it becomes hard for the body to get enough oxygen. Pulmonary fibrosis is the term for scarring of the lungs.
It refers to a variety of progressive conditions and disorders that result in inflammation and heavy scarring of the lung tissue. Because scarring of the sensitive lung tissue causes hardening and inflexibility of the lungs, the lungs are unable to expand to their normal size. This irreversible condition greatly reduces breathing capacity and prevents life saving oxygen from properly traveling through the bloodstream.
While most cases of interstitial lung disease occur at a gradual progression, other cases appear more rapidly and their causes are unknown. Treatment options sometimes vary and while prescription medicines can slow the progression of interstitial lung disease, it is often not enough to help a patient recover full breathing capacity.
The major symptoms of interstitial lung diseases include:
Shortness of breath which increases due to exertion
Types of Interstitial Lung Disease-
Any sort of interstitial lung disease causes thickening of the interstitium which may be due to extra fluids, inflammation or scarring. Some types may be short lived; however, some could be chronic and really painful.
Some of the kinds are discussed below:
Interstitial Pneumonia: This is caused due to infection in the interstitium of the lungs by bacteria, fungi or viruses. The most common cause being a bacteria named Mycoplasma pneumonia.
Idiopathic Pulmonary Fibrosis: Although the cause is unknown, this is a chronic form of scarring of the interstitium.
Hypersensitivity Pneumonitis: This lung problem is caused due to excessive inhalation of dust, mold or other sort of irritants.
Non-specific Interstitial Pneumonitis: These are the kinds of lung problems, which are presented with autoimmune conditions such as scleroderma or rheumatoid arthritis.
Acute Interstitial Pneumonitis: This is a sudden and intense lung disease which usually requires life support.
Cryptogenic Organizing Pneumonia: This is a kind of interstitial lung disease but without the presence of any infection.
Desquamative Interstitial Pneumonitis: This is partially caused due to smoking.
Asbestosis: As the name suggests, this is caused due to prolonged exposure to asbestos.
Sarcoidosis: In this condition, lymph nodes are swollen along with lung disorders. Often heart, eye, skin and nerve involvement also occurs.
Homeopathic Treatments For Interstitial Lung Diseases-
The most common treatments are as follows:
Beryllium: This can be the remedy for formation of nodules or granulomas that usually form in the lungs, in other body organs or systems. This particular medicine has been very useful in the treatment of sarcoma. This can be provided to individuals who have difficulty in breathing and enormous pain in the lungs, have dry coughs etc.
Silica: In case of characteristic scarring and thickening of the inner lung layers, this medicine can be prescribed. This remedy helps enormously in relieving cold, sharp lung pains, coughing with very thick phlegm and haemorrhaging capillaries.
These are the most common medications; however there are numerous others that can help relieve lung disorders.
Bacterial sinus problems of viridians strep with s.epidermidis .which homeo medicines should I take for a long time (immunity enhancement at the same time. Please give me advice.
My 8 years old son gets cough and cold often what is the correct medicine for him he has breathing problem to he has mild heart valve problem with. Doctor said not to worry he his not taking any medicine for it.
My father is suffering from cerebral sinus thrombosis. They have blood clots in superior superior sagittal sinus & right transverse sinus. 15 days ago, they came across stroke, after stroke we had hospitalized them. Doctor gave him treatment of LMWH & now he is on xarelto for min. 2 years. Doctor said he have deficiency of protein C & S. And told us to check clotting status after 3 months. Now he is able to walk ,speak, and do all other activity as earlier. But still I need second opinion. Is possible to get reed of this clotting through operation or current treatment of Anti coagulation is right for them. Please suggest some specialist.
Hello doctor, I have tonsil problem in my neck my voice is also down what can I do ,today is 7 day to face this problem.
Hi doctors, my friend as breathing problem for past one week for 5 to 10 minutes daily but it increased and I got feared lot and mom did some First aid now she is ok and she as low hemoglobin Level and she become tried very soon and because of it she can't able to concentrate on anything. please help me out of it. My kindly request to all. Thank you so much to all.
Although your body is already in possession of the bacteria leading to tuberculosis, your immune system is able to prevent you from becoming sick. Doctors have made a distinction between latent and active tuberculosis (TB). In case of latent TB, the bacteria in the body in a passive state and it causes no symptoms, and therefore it is not contagious. But, in the case of active TB, you would become sick and may even spread the disease to others. It can take place in the first few weeks or even after several months of being infected with TB bacteria.
What are the symptoms of active TB?
- If you are coughing for over three weeks and sometimes even coughing up blood, it can be a sign of TB.
- Chest pain and pain while coughing and breathing along with fatigue, fever, chills and night sweat are the common symptoms of TB along with loss of appetite and unintentional weight loss. TB may even affect other organs of your body, including your brain, spine and kidneys.
- When TB takes place outside the lungs, then the signs of TB can vary as per the organs that are involved. For instance, TB in the spine can cause back pain and that in kidneys may cause blood in the urine.
What are the causes of TB?
TB is caused by a bacteria which spreads from individual to individual via the microscopic droplets that are released into the air. This may happen when an affected person is left untreated and he speaks or sneezes or coughs or laughs.
Though the disease is contagious, it is not easy to be affected by it. As a result, you are much more likely to get affected with active tuberculosis from a person you live with or come in regular contact with, rather than a stranger. It is important to note here that people who are affected with TB and going through proper medications for over two weeks are no more contagious.
Right from the 1980s, the number of individuals affected with TB has increased dramatically, owing to the spread of HIV, which is the virus known for causing AIDS. A person infected with HIV has a weak immunity system as a result of which it becomes difficult for the body to deal with TB bacteria. So those who have AIDS are more likely to be affected with active TB and sometimes the latent form also progresses to an active one very quickly. Therefore, it is important to seek medical assistance and detect if you have any such health complications concerning TB.
Hi doctor I am feeling breathlessness from past one year I do not know why it is happening I will feel shortness of breath only in rest. What is the cause and what medications should I take to relive this problem please help me out I do not have any cough or other symptoms except this.
Mere chest m seeing lene m problem h doctors se checkup karwa to allergic problem bahut h please help me in best treatment suggest me best medicine for lungs allergic problem.
I am 20 years old female .I often get breathing difficulty .sever dysnea even at rest .its very hard for me to manage .what is the solution?
Lung cancer is also known as pulmonary carcinoma or cancer of the lung. It occurs when DNA mutations develop in the cells/ tissues of the lungs leading up to uncontrolled growth in the tissues of the lung. By far, it is known to be the most common cancer in Asia.
1. Type: lung cancers can present as one of the following types:
- Non-Small Cell Lung Cancer (NSCLC): Most common type of lung cancer and constitutes nearly 85% of all lung cancers. The sub-types of NSCLC are as follows:
- Large cell carcinoma
- Squamous cell carcinoma (SqCC) (Epidermoid)
- Adenocarcinoma – accounts for majority of the NSCLC.
- Small Cell Lung Cancer (SCLC): It is also known as oat meal cancer and tends to spread (metastasize) quickly. This constitutes about 15% of the lung cancers.
- Mesothelioma: It is a rare cancer that develops in the mesothelial cells of the pleural or peritoneal surfaces. It usually arises in the pleural membrane lining the lungs, known as pleural mesothelioma. One that arises from the peritoneum is called the peritoneal mesothelioma and the one that arises from the pericardium is known as pericardial mesothelioma. Lastly, it can also arise from the tunica vaginalis known as testicular mesothelioma. People working with or prior exposure to asbestos are mostly at risk of developing mesothelioma. The latency period between time of exposure and development of mesothelioma can be somewhere between 20 to 40 years. Maximum of the patients who develop mesothelioma are men.
2. Gender: It affects the male populace predominantly. It is more common in men than in women and in those of lower economic status. However, the incidence of lung cancer, in women too, is on the rise of late.
3. Etiology: Cigarette/ Tobacco smoking remains the most important cause of lung cancer accounting for 85 – 90% of the cases. Incidence/ risk is proportionate to the number of cigarettes smoked irrespective of the age. Also, environmental toxins including smoke from burning black tar, exhaust gases from automobiles etc. too contribute actively to various lung diseases including cancer. People working in asbestos manufacturing factories who are exposed to asbestos dust are also likely to get lung cancer. Tuberculosis too is an additive risk factor. Again, people who have received ionizing radiation especially to treat Hodgkin Lymphoma or other malignancies also run the risk of developing lung cancer. Above-mentioned causes apart, genetic factors may also play a role.
4. Features: Lung cancer clinically presents in the following ways mainly.Signs & symptoms of malignant mesothelioma are as enumerated below
1. Difficult/ labored breathing (Dyspnea)
2. Chest pain
3. Palpable chest wall mass
4. Discordant chest wall expansion
5. Weight loss (Cachexia)
6. Loss of appetite (Anorexia)
7. Night sweats
Signs & symptoms of non-small cell lung cancer (NSCLC) are as enumerated below. Majority of patients are symptomatic at diagnosis
8. Chronic cough
9. Difficult/ labored breathing (Dyspnea)
10. Chest pain
11. Blood stained sputum (Hemoptysis)
13. Weight loss (Cachexia)
14. Loss of appetite (Anorexia)
16. Bone pain
17. Pleural or pericardial effusion
18. Superior vena cava syndrome
19. Brachial plexopathy
20. Neurologic pain
21. Hypercalcemia of malignancy
Signs & symptoms of small cell lung cancer (SCLC) are as enumerated below
Symptoms as per the points 8 – 18 depicted above for NSCLC are applicable for SCLC as well. Additionally, patients suffering from SCLC may have:
23. Horner syndrome
5. Screening: is generally recommended for asymptomatic/ symptomatic populations as surveillance for high risk individuals – who are either current or former smokers (quit smoking within the last 15 years), have at least a 30 pack year smoking history and those who do not have any prior history of lung cancer. The goal of screening, as usual, is to be able to detect & diagnose lung cancer at an early stage which is potentially curable. It is mostly radiologic with a low dose helical computed tomography (CT) scan being more effective in detecting early stage lung cancer than a chest radiograph can.
6. Diagnosis: Abnormal blood test results may be indicative of malignancy, but a follow up imaging/ biopsy is always the gold standard for accurate diagnosis. Following are the diagnostics employed mainly:
- Blood: Hb may be low, TLC, ESR and polymorphs increased. Adenocarcinomas are likely to express thyroid transcription factor 1 (TTF-1) or carcinoembyonic antigen (CEA). On the other hand, mesotheliomas are likely to express Wilms Tumor -1 (WT-1) protein and Calretinin.
- Imaging: Thoracoscopy, Bronchoscopy, X-Ray, CT Scan etc all. Positron Emission Tomography (PET) / CT scan and Magnetic Resonance Imaging (MRI) scan help detect metastasis, if any.
- Biopsy: It clinches the histologic diagnosis, and the nature of the disease.
7. Treatment: Conventional treatment includes surgery, chemotherapy and radiotherapy as contextually appropriate. Simultaneously, an adjunctive or integrative naturopathic treatment with suitable complementary & alternative medicines (CAM) too can help improve clinical outcomes and facilitate recovery as would be feasible contextually.
8. Prognosis: preventive measures, earlier diagnosis and right early treatment is key for an effective therapeutic management & better prognosis. Like most other cancers, the chances of cure for an early stage lung cancer are more. The cure/ recovery chances are influenced by the grade, stage of cancer, recurrence and the patient’s general health & vitality etc all. The primary determinant of prognosis in NSCLC is the stage at which the cancer is diagnosed. For non-metastatic cancers, however, it is the nodal status that determines the stage and hence the prognosis.
9. Prevention: rightly said, prevention is always a better choice. Cigarette smoking is to be avoided by all means as it is the single major cause of lung cancer. Even exposure to cigarette smoke (passive or secondhand) is also an established cause of lung cancer and is known to increase the risk of lung cancer in non-smokers as well. Preventing exposure to secondhand smoke can be helpful in decreasing the incidence and mortality from primary lung cancers. Above-mentioned apart, other important risk factors such as exposure to ionizing radiation, environmental carcinogens like smoke from burning black tar, exhaust gases from automobiles, outdoor air pollution, and occupational exposure to asbestos, arsenic, beryllium, nickel, cadmium, chromium etc all too are known to increase the risk for lung cancer and mortality thereof. In fact, cigarette smoking is known to potentiate the effect and hence the lung cancer risk of many of the above-mentioned carcinogens, multi-fold, in smokers. Thus, either eliminating or reducing the exposure to the above-mentioned carcinogens can lead to a decrease in the risk of lung cancer and incidences thereof. Furthermore, randomized clinical trials indicate that high intensity smokers (only) who take supplementation of beta-carotene have an increased risk/ incidence of lung cancer. Vitamin E supplementation, on the other hand, does not affect the risk of lung cancer as indicated by the trials. If you wish to discuss about any specific problem, you can consult a doctor.