Chest Diseases and the Common Man

Anti TB Treatment in India Needs to be Improved

2013-05-05T23:00:00.001+05:30

Source: Anti TB Treatment in India Needs to be Improved

India has the highest burden of tuberculosis in world accounting for 20% of global incidence of TB. Recently, a survey of tuberculosis prescription practices in private and public sector in India was published in the current issue of National journal of integrated research in medicine by Dr. Gyanshankar Mishra from Nagpur, India. The study found that more than 90% prescriptions in the private sector and RNTCP (Revised National Tuberculosis Control Programme) were incorrect as per the WHO (World Health Organization) norms. The study further showed that factors for development of drug resistant TB were more in prescriptions by private practitioners whereas overdoses of anti TB medicines were more in RNTCP. The study notes that the patients above 30 kg in RNTCP receive the same dose of all anti TB drugs except Rifampicin. As a result a person weighing 30 kg receives 300 mg of INH whereas another person weighing 31 kg receives 600 mg of INH , thus receiving almost double the recommended dose of 10 mg per kg. The study has recommended creation of weight bands under RNTCP for persons weighing more than 30 kg. The study concludes that the anti TB treatment offered in private and public sector in India at present is not satisfactory and needs to be improved.

Link to article:

http://www.scopemed.org/fulltextpdf.php?mno=36915

The abstract of this article is given as below.

Introduction: India has the highest burden of tuberculosis in world, accounting for 20% of global incidence of TB (Tuberculosis). TB treatment is available both in private and public sector in India.

Aim & objectives: The current study was carried out to study and compare the prescribing practices of anti-tuberculosis medications by private practitioners and healthcare providers in public sector (under RNTCP-Revised National Tuberculosis Control Programme).

Material and Methods: 105 anti TB prescriptions of private practitioners and 105 RNTCP (Revised National Tuberculosis Programme) treatment cards were analysed.

Results: 9.52% prescriptions by private practitioners and 4.76 % RNTCP prescriptions were correct. Factors for drug resistance were present in 67.62 % of prescriptions by private practitioners and 28.57 % of RNTCP prescriptions whereas overdosing was present in 53.33 % of prescriptions by private practitioners and 68.57 % of RNTCP prescriptions.

Conclusion: The anti TB treatment offered in private and public sector in India is not satisfactory at present and needs to be improved

Reference: Mishra G, Mulani J. Tuberculosis Prescription Practices In Private And Public Sector In India. NJIRM. 2013; 4(2): 71-78.

Diabetes Interferes in Lung Functions of Asthma and COPD Patients

2013-04-13T00:39:00.001+05:30

Diabetes Interferes in Lung Functions of Asthma and COPD Patients

Has anyone ever explained why you have COPD?

2012-03-12T17:19:00.002+05:30

Has anyone ever explained why you have COPD?

Classic COPD appearences as pulmonary enphisema & Chronic bronchitis

Make the following experiment: Inhale as much as you can, fill your lungs with air and hold your breath. Now, exhale a little, and soon after hold your breath. From this point (even with lungs full of air), to breathe again, but based on this interval.
It is exactly this way that a COPD patient breathes with lungs full of air, but with an ability to Exhale (put the air out) Limited.
This is because COPD, an acronym for Chronic Obstructive Pulmonary Disease (more commonly known as emphysema or chronic bronchitis), causes an inflammation in the bronchi of the lungs that obstruct the air passage. As the air out of the lung must be “pushed” by a positive pressure generated by the muscles, he finds difficulty and became trapped, leads to hyperinflation, one of the reasons for the lack of air or oxygen.
COPD
COPD is a disease still largely unknown by most people, including their holders.
The profile of the person with COPD is generally a person smoking, about 40 years and that has as its main symptoms are cough and shortness of breath.
Smokers think the cough is a natural product that comes “free” with the cigarette and that one day will pass … Big mistake! The cough does not cease, by contrast, tends to worsen and the smoker becomes accustomed to thinking that the cough is normal!
Diagnosis of COPD
The vast majority of people who smoke because they think they made a chest x-ray recently, and this is with the report “normal.” Unfortunately the picture is not all! The chest radiograph may be normal, even though the patient may have COPD.
The lab exam that diagnoses COPD is spirometry or pulmonary function test (also known as “blow test”). The spirometry assesses lung function data that may indicate to be a smoker with COPD.
But remember: Smoking causes 52 different diseases and COPD is one of them!
Tobacco Industry & COPD smoker
For the “happiness” of tobacco industry, as cigarettes industries, smokers think they can quit at any time. This, for the vast majority of people do not happen, for one simple reason:

Cigarettes contain nicotine that is an addiction substance, provokes quimic dependency and makes very difficult to quit smoking!
Accordind to PULMAOSA Medical Editor, Dr. Marcos Nascimento: “Quit smoking without medical supervision is extremely difficult, only 3-5 people among 100 do. Hence the need to search for medical and psychological help to start a cognitive behavioral treatment, complement Dr. Nascimento. And if you need to use medication to alleviate withdrawal symptoms – which is that irrepressible desire to return to smoking, there are some medicines available today. Thus, the treatment of smokers have a greater chance of success and you can prevent the progression of COPD.
Tobacco Industries and its Marketing Policy
Like any commercial enterprise, tobacco industries target PROFIT, and just want to be able to pay their shareholders. Tobacco Industries obviously know that the customer can get sick! In fact, it’s just knowing that your customers will get sick and may die or cease to be customers, they have developed a highly focused marketing on young people and women to feed back their customer base and therefore continue their lucrative business.
There is a Chinese saying that someone asks when is the best time to plant a tree. And the answer says that the best time was twenty years ago. The second best time is now!
Therefore, so it is with COPD and smoking: The Best, would be no smoking at any time, but will ALWAYS be an excellent time to STOP SMOKING. Therefore, seek the help of a pulmonologist to informs you about the dangers of smoking and lead the best treatment for COPD.
Sources:
PULMAOSA- Lungs: Your Atmosphere, Your Life!

This Diwali remember – What you burn is what you breathe!

2011-10-26T22:32:00.001+05:30

As sure as Diwali is a festival of lights, sweets, gaiety, splendor & fireworks, it is also one of deafening noise, blinding light, risky fire & suspended particles. And this has direct effects on our health & environment. When the entire nation looks forward to Diwali as a celebration of life, patients suffering from Asthma & COPD (Chronic Obstructive Pulmonary Disease) begin readying there lifesavers – Inhalers, nebulizers or whatever gives them a breath of life. For these people Diwali is not a festival of light & gaiety but that of smoke, coughing & wheezing.

Fireworks are sources of some of the highly toxic inhalants produced during Diwali celebrations. Firecrackers are “power packed” with potassium nitrate, carbon & sulfur. Apart from this they also contain toxic contents like copper, cadmium, lead, manganese, magnesium, zinc, sodium, potassium, and aluminum powder & barium nitrate. When ignited, the crackers burst allowing these powerful chemicals to come in contact with atmosphere and the smoke thus generated contains increased amounts of carbon monoxide, carbon dioxide, nitrogen dioxide, hydrocarbons, hydrogen sulfide & particulate matter which worsen the quality of Diwali air. The suspended particles hog like a thick blanket reducing visibility and suffocating the atmosphere. In fact studies have demonstrated that during Diwali festival the concentration of sulfur dioxide increased by 10 times & that of nitrogen dioxide, PM10(Particulate matter of size less than 10 microns) & TSP(Total Suspended Particles) increased by 2 to 3 times. The Overall air pollution during Diwali increases by about 200 %. The biggest culprits among firecrackers are the colour sparkles (“Phuljari”), “Anar”, “Chakri”, Fire pencils, Snake tablets & “Hydrogen” bomb.

A special mention may be made of PM10. With the average PM10 charge, we inhale millions of fine particles with each breath. The larger particles( 5 to 10 microns) are filtered in the nose & throat, smaller particles (3 to 5 microns) arrive in the bronchial tube, bronchi (2 to 3 microns), bronchioles (1 to 2 microns) & in alveoli (0.1 to 2 microns) & finally in the blood. These particles can no longer be coughed up & as deposits lead in long term to inflammation, particularly in asthmatics, & also with healthy people, although they may not notice the immediate irritant effects.

When we inhale such a highly toxic and polluted air during Diwali, how can escape from its ill effects? The harmful oxides present in the Diwali fumes come into contact with the moisture while passage from the nostrils to the lungs & form acids which cause immense damage to the body.

The Diwali smoke potentially leads to development of various respiratory ailments like –Allergic bronchitis, acute exacerbation of bronchial asthma & COPD (Chronic Obstructive Pulmonary Disease), allergic rhinitis, laryngitis, sinusitis, pharyngitis, common cold, acute eosinophilic pneumonia, reactive airway dysfunction syndrome, etc.

Children, pregnant women, asthmatics & senior citizens are highly prone to these potentially harmful effects of Diwali smoke.

Here is a list of precautions that need to be followed during Diwali celebrations.

Precautions to be followed by asthmatics:

1. Stay away from people burning crackers.

2. Keep the inhalers and other medicines ready beforehand (both maintenance & reliever medications).

3. Consult your doctor and start maintenance dose of inhalers a few days before the festival & continue the same two days after Diwali.

4. In severe cases rescue medications need to be taken & if not relieved contact your doctor immediately.

5. Better do not venture out in the evening of Diwali. Stay in company of friends and family members in house.

6. If need to venture outside use masks (N95 masks have been technically recommended).

7. Consult your doctor regarding pulmonary vaccination in advance.

8. Stay away during colouring and white washing of house before Diwali because these also act as “triggers” of an asthma attack.

9. If possible plan a visit to some hill-station / ecoclean place (which is not much crowded) during Diwali festival.

Precautions to be followed by every one of us during Diwali festival:

1. Avoid /decrease the firework celebrations & play “ecosafe” Diwali.

2. Enjoy Diwali with lamp, lanterns & diyas.

3. Fireworks if carried out should be done in open grounds, away from residential areas & during fixed time limits.

We should remember that one person’s idea of fun could be an asthma patient’s nightmare. Asthma patients have as much right as us to stick around and enjoy Diwali. And ultimately for our own benefit we should not forget that “what we burn is what we breathe”, this Diwali.

Author:

Dr. Gyanshankar Mishra

MBBS, MD(Pulmonary Medicine), DNB(Respiratory Diseases)

Chest Physician, Nagpur

email address: chestcareclinic@gmail.com .

Swine flu revised guidelines - India

2010-08-29T20:47:00.004+05:30

So far, the present guidelines stipulate that a person suspected of influenza A H1N1 need to be referred to an identified govt. health facility. He/she needs to be kept in an isolation facility in that hospital and if found positive, is treated accordingly.

In order to make the testing facility for H1N1 more accessible at large and due to the onset of the Influenza season in the country, it has been decided to revise the existing guidelines.

Under the new guidelines, any person with flu like symptoms such as fever, cough, sore throat, cold, running nose etc. should go to a designated Government facility for giving his/her sample for testing for the H1N1 virus. After clinical assessment, the designated medical officer would decide on the need for testing. Except for cases that are severe, the patient would be allowed to go home (This was not allowed under the existing guidelines).

The sample of the suspect case would be collected and sent to the notified laboratory for testing. If tested as positive for H1N1 and in case the symptoms are mild, the patient would be informed and given the option of admission into the hospital or isolation and treatment at his own home.

In case the patient opts for home isolation and treatment, he/she would be provided with detailed guidelines / safety measures to be strictly adhered to by the entire household of the patient. He/ she would have to provide full contact details of his entire household. The house hold and social contacts would be provided with the preventive treatment.

Notwithstanding the above guidelines, the decision of the doctor of the notified hospital about admitting the patient would be final.

In case the test is negative, the patient will accordingly be informed.

These guidelines have been issued by the Government in public interest and shall be reviewed from time to time depending on the spread of the pandemic and its severity in the country. These guidelines would however not apply to passengers who are identified through screening at the points of entry. The existing policy of isolating passengers with flu like symptoms would continue.

TB: Why you should not discriminate

2010-08-19T20:53:00.002+05:30

Impact of Stigma and Discrimination

Tuberculosis is an infectious disease caused by bacteria that any person can get. It is not a hereditary disease or a curse of God. It can be completely cured by taking regular and complete treatment. Stigma and discrimination against people diseased with TB can occur in many settings at the workplace, health care facilities, or within the community. Its manifestation can be as dramatic as physical violence or as subtle as avoidance. However, it is totally unnecessary and primarily based on myths. Stigma is as old as history. Stigma and discrimination against people infected with TB can occur in many settings at the workplace, healthcare facilities, or within the community. Its manifestation can be as dramatic as physical violence or as subtle as avoidance. However, it is totally unnecessary and primarily based on myths. Beyond the economic consequences, stigma and discrimination against people with TB have a devastating social and psychological impact. Such attitudes obstruct health care providers in delivering effective treatment. Stigma often prevents people from seeking health care attention, which constitutes a direct public health threat to the community. Even when patients attend treatment, social disapproval of their family or community members decreases compliance with treatment. Proper adherence, however, is critical to avoid the development of multi-drug resistant TB (MDR-TB). Social isolation, experienced rejection, shame and blame due to TB diagnosis can lead to psychosomatic stress, loneliness and feelings of hopelessness.

Some of the causes of stigma & discriminationinclude:
•Lack of knowledge about TB transmission, diagnosis and treatment.
•Association with conditions already stigmatized particularly HIV/AIDS, poverty, malnutrition, migration and poor hygienic living conditions.
•People with TB are often seen as being responsible for becoming infected.
• People living with TB are seen as guilty of infecting others.
• Lack of protective equipment for health care workers.
• Lack of access to treatment.

TB related stigma and discrimination can be minimized!

It is important that employees and healthcare professionals understand the determinants and dynamics of stigma to ensure that they prevent the violation of human rights, that patients seek timely advice and achieve good treatment adherence. It is suggested that company management implement the following strategies to minimize TB related stigma and discrimination at the workplace:

•Provide a supportive work environment, where people can disclose their TB status without the threat of being stigmatized and risk losing their jobs. Have in place a policy that addresses this so that workers don’t lose their jobs because of being diagnosed as TB; rather such TB patients are provided proper care and access to DOTS services.

• Influence people’s attitudes through awareness about TB, to provide up to date information on TB epidemiology, diagnosis, transmission, treatment and address TB related stigma and discrimination. Increasing factual knowledge should be followed by experiential learning, which helps employees reflect their own attitude about TB and understand individuals affected by TB stigma and discrimination.

•Involve those with personal experience with TB and set up “Support Groups”. Such groups can encourage the exchange of experiences related to TB and address issues concerning social and workplace support.

• Initiate workplace campaigns to change attitudes. The aim of these campaigns is to provide accurate, up-to date information on TB (‘TB is curable’).

• Develop sustainability of TB anti-stigma campaigns through partnerships with private and public national and international companies.

• Respect confidentiality. Risks of disclosure might include negative responses, such as rejection, isolation and loss of employment. This can result in poor treatment adherence and/or the spread of TB to other employees.

•Link with existing HIV/AIDS anti-stigma workplace initiatives.

•Ensure occupational safety for health care staff and appropriate working conditions for all, e.g. ensuring good ventilation of premises and/ or applying air filtration. TB anti-stigma interventions should be in place in every company.

Source: Adapted from ICN Document: TB/MDR TB Related Stigma and Discrimination.

Contents in tobacco smoke

2010-07-27T23:09:00.000+05:30

Just have a look at what a tobacco smoke contains and the relevance of those contents in our lives!

The real facts about tobacco

2010-07-27T23:05:00.001+05:30

Tobacco smoke has negative effects on nearly every organ of the body and reduces overall health.^[1]
Tobacco smoke contains over 4,000 chemicals, including at least 50 that cause, initiate or promote cancer such as tar, ammonia, carbon monoxide, oxides of nitrogen and benzopyrene.^[2]
In 2001, over 40 billion cigarettes (42,301 billion) were sold in Canada.^[3]
Child labour is widespread in all major tobacco producing countries.^[4]
Smoking in movies is thought to be the most powerful pro-tobacco influence on teens today, accounting for 52% of adolescents who start smoking, an effect even stronger than cigarette advertising.^[5]
The prevalence of smoking in Canada is declining among youth. In 2008, across the country, 15% of youth 15 – 19 years old reported that they were regular smokers. This number has not changed from the same period one year before.^[6]
In Ontario, youth are smoking even less. Only 11.9 % of students in grades 7 – 12 reported that they smoked daily in 2007. This number is down from 22% in 1999.^[7]
Breathing in second-hand smoke causes over 1,000 deaths in Canadian non-smokers from lung cancer and heart disease every year.^[8]
A non-smoker in a smoky room is inhaling the same chemicals as a smoker.^[9]
The earlier you start smoking, the higher your chances are of becoming addicted to nicotine and continuing to smoke as an adult.^[10]
Most youth who smoke want to quit but few succeed.^[11] One study found that among youth who smoke, 77 percent have made one or more serious quit attempts in the last year but few of these are successful.^[12]
If you are caught supplying or selling tobacco to youth you can be fined hundreds or even thousands of dollars for breaking the law.
Your choice to smoke is affected by factors such as your beliefs and attitudes, your culture, the communities you live in, your friends and family and even whether you are stressed or feel unsafe.^[13]
Cannabis smoke is potentially carcinogenic in the same way that cigarette smoke is. Cannabis smoke contains over 400 chemicals, many of them carcinogenic.^[14]
Youth who smoke are more likely to be depressed during their teens and even into their twenties.^[15]
Teens who smoke cigarettes may be less likely to eat a healthy diet and exercise regularly.^[16]
People who smoke are less likely to exercise.^[17]
Smokers who want to become more physically active may find it difficult to get past the early stages of exercise because they have trouble breathing.^[18] As a result they often become discouraged and give up.
According to researchers at Stanford University if you are next to a person smoking outdoors, you can breathe in smoke that is much more concentrated than normal air pollution levels. In fact, being within a few feet of a smoker outdoors may expose you to air pollution levels that are similar to levels measured in homes and bars.^[19]
In 2008, 33% of Canadian youth ages 15-19, tried little cigars or cigarillos and 10% had smoked a little cigar or cigarillo in the past 30 days. ^[20]
A larger number of young adults ages 20-24 (50%) tried little cigars or cigarillos and 13% reported smoking a little cigar or cigarillo in the past 30 days. ^[20]

Footnotes:

[1]: Health Canada Website, Accessed March 15, 2007: http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/body-corps/index-eng.php
[2]: Health Canada Website, Accessed March 15, 2007: http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/fact-fait/fs-if/index-eng.php
[3]: CCTC Website: Industry Watch FAQs Accessed March 16, 2007. http://www.cctc.ca/cctc/EN/industrywatch/faqs
[4]: World Health Organization Website: Accessed March 16, 2007, http://www.who.int/mediacentre/news/releases/2004/pr36/en/
[5]: Dalton, M.A., et.al. (2003). Effect of smoking in movies on adolescent smoking initiation: a cohort study. Published by the Lancet, online June 10, 2003. Accessed March 17, 2007 http://smokefreemovies.ucsf.edu/pdf/Dalton-Lancet.pdf
[6]: Canadian Tobacco Use Monitoring Survey: Health Canada Website http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/research-recherche/stat/_ctums-esutc_2008/wave-phase-1_summary-sommaire-eng.php
[7]: Centre for Addiction and Mental Health. (2007). Drug Use Among Ontario Students 1977 – 2007. The results of the Ontario Student Drug Use and Health Survey. Released November 20, 2007. http://www.camh.net/Research/Areas_of_research/Population_Life_Course_Studies/OSDUS/ OSDUHS2007_DrugDetailed_final.pdf
[8]: Makomaski Illing, E.M., & Kaiserman, M.J. (2004). Mortality attributable to tobacco use in Canada and its regions, 1998. Canadian Journal of Public Health, Jan-Feb:95(1):38-44.
[9]: United States Environmental Protection Agency. (1992). Respiratory health effects of passive smoking: lung cancer and other disorders (p 3-2). Washington, DC: Indoor Air Division, Office of Atmospheric and Indoor Air Programs, Office of Air and Radiation.
[10]: Milton, M.H., Maule, C.O., Yee, S.L., Backinger, C., Melarcher, & A.M., Husten, C.G. (2004) Youth Tobacco Cessation: A Guide for Making Informed Decisions. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.
[11]: Sussman S. (2002). Effects of sixty six adolescent cessation use trials and seventeen prospective studies of self-initiated quitting. Tobacco Induced Disease, 1, 35-81.
[12]: Hollis J.F., Polen MR, Lichtenstein E, & Whitlock EP. (2003). Tobacco use patterns and attitudes among teens being seen for routine primary care, American Journal of Health Promotion 17(4): 231-9.
[13]: Kaczynski AT, Manske SR, Mannell RC, Grewal K. Smoking and physical activity: A systematic review. American Journal of Health Behaviour. 2008;32(1):93-110.
[14]: Conwell, L.S., O'Callaghan, M.J., Andersen, M.J., Bor, W., Najman, J.M., & Williams, G.M. (2003). Early Adolescent Smoking and a Web of Personal and Social Disadvantage. Journal of Paediatrics and Child Health, 39, 580-585.
[15]: Centre for Addiction and Mental Health (CAMH) Understanding the Effects and Risks of Cannabis Use: Frequently Asked Questions and Answers. http://www.camh.net/About_Addiction_Mental_Health/Child_Youth_Family_Resources/ Cannabisfactsheet4effects.pdf
[16]: Chaiton M, Zhang B. Environment modifies the association between depression symptoms and smoking among adolescents. Psychology of Addictive Behaviors 2007 Sep;21(3):420-424. http://www.ncbi.nlm.nih.gov/pubmed/17874894?ordinalpos=1&itool=EntrezSystem2.PEntrez. Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
[17]: Larson NI, Story M, Perry CL, Neumark-Sztainer D, Hannan PJ. Are diet and physical activity patterns related to cigarette smoking in adolescents? Findings from project EAT. Preventing Chronic Disease 2007 Jul;4(3):A51. – pdf full text http://www.cdc.gov/pcd/issues/2007/jul/pdf/06_0053.pdf
[18]: Costakis CE, Dunnagan T, Haynes G. The relationship between the stages of exercise adoption and other health behaviors. American Journal of Health Promotion. 1999;14:22-30.
[19]: Klepeis NE, Ott W, Switzer P. Real-time measurement of outdoor tobacco smoke. Journal of the Air and Waste Management Association 2007 May;57(5):522-34. http://secure.awma.org/journal/pdfs/2007/5/10.3155-1047-3289.57.5.522.pdf See also: http://news-service.stanford.edu/news/2007/may9/smoking-050907.html
[20]: Canadian Tobacco Use Monitoring Survey: Health Canada Website http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/research-recherche/stat/_ctums-esutc_2008/wave-phase-1_summary-sommaire-eng.php Ref: http://www.smoke-fx.com

FAT EMBOLISM

2010-07-13T20:30:00.000+05:30

Introduction:

Fat embolism
It is a common pathological finding following long bone fracture especially with lower limb fractures e.g. Femur and Pelvis. It is common in fractures that have not been immobilized.
It can also occur after:
- Prosthetic joint replacement
- Cardiac massage
- Liver trauma
- Burns
- Marrow transplant
- Marrow biopsy
- Rapid high altitude decompression and liposuction
- Non traumatic etiology: Fatty liver, prolonged corticosteroid therapy, acute pancreatitis, osteomyelitis, conditions causing bone infarcts such as sickle cell disease.
It may occur in previously young and healthy individuals. More common 24 – 72 hours post fracture.

Pathology:

Marrow fat enters the circulation and lodges in the lungs causing mechanical obstruction.

Clinical features:
1. Hypoxia
2. Coagulopathy with transient petechial rash on neck, axilla and skin folds.
3. Neuro disturbance: confusion, disorientation, coma.
4. Clinically stable patients may deteriorate with low grade fever, petechial rash, hypoxia and confusion.
5. Jaundice and renal dysfunction are possible.

GURD’S criteria for diagnosis of Fat pulmonary embolism:
Major:
1. Axillary or subconjunctival petechial
2. Hypoxemia (PaO2<60 mm Hg, FiO2 110/min)
2. Pyrexia (Temperature >38.5 degree celcius)
3. Emboli present in retina on fundus examination
4. fat present in urine
5. Sudden unexplained drop in hemotocrit or platelet values
6. Fat globules present in sputum
7. Increasing sedimentation rate
Diagnosis requires at least 4 major and 1 minor criteria.

Diagnosis:
-Clinical suspicion in patients with lower limb fractures presenting with tachypnoea and hypoxia.
-Fat globules in urine.
Chest radiograph: Bilateral alveolar infiltrates. ARDS can develop.

CT Thorax: ground glass opacities / nodular opacities- centrilobular, subpleural
V/Q SCAN: perfusion scan shows multiple peripheral subsegmental defects.
Echocardiographic findings: Fat embolism can be identified in real time during orthopedic procedure.
Imaging recommendations:
Chest radiograph is usually adequate for detection of lung disease and monitoring disease course.

Differentials:
ARDS, Hydrostatic pulmonary edema, neurogenic pulmonary edema, Infection, Pulmonary hemorrhage, Acute venous thrombo embolic disease, Pulmonary contusion, Aspiration.

Treatment:
1. Immobilization of fracture site.
2. Fluid replacement
3. Oxygen
4. Supportive care.

You Can Control Your Asthma

2010-05-05T07:02:00.002+05:30

4^th May 2010 is the World Asthma Day. The theme of World Asthma Day 2010 is "You Can Control Your Asthma". On this occasion it is important for all of us to be well informed about the various aspects of asthma and spread awareness about the same.

A very important fact about asthma is that it cannot be cured but can definitely be controlled. People with asthma can live normal active life provided their asthma is controlled. Thus asthma does not have to necessarily limit one’s life.

Nowadays we have specialist doctors who specialize in treatment of respiratory diseases (Chest Physicians) and it’s better to have a specialist opinion right at the onset before the disease progresses.

People have asthma for many years. The main complaint an asthmatic faces is trouble in breathing. During asthmatic attacks (Acute severe asthma) chest tightness, coughing and wheezing episodes are the main clinical complaints. Patients might be absolutely normal in between two asthmatic attacks. Asthmatic attacks vary in severity from mild to very severe cases which can turn out to be fatal. Most of the times these patients wake up at night due to coughing or breathlessness.

What is asthma?

Asthma is a disease involving the airways in the lungs. The main function of the airways is to carry air in and out of the lungs. In asthma airways become smaller and smaller and also more thickened (Airway remodeling). When asthma is under control, the airways are clear and air flows easily in and out. When asthma is not under control, the sides of the airways in the lungs are always thick and swollen. In such a situation, an asthma attack can happen easily. During an attack, the airways get squeezed and also make mucus. Thus during an asthma attack, less amount of air can get in and out of the lungs. This is manifested coughing and wheezing in asthmatic patients. The chest feels tight during such attack.

The airway function is measured objectively by spirometry or the so called pulmonary function test which helps in the diagnosis of asthma.

You can get asthma at any age however you cannot catch asthma from other people. Many times it runs in families.

How to control your asthma and keep asthma attacks from starting:

1. Take asthma medicines regularly and as per the instructions of your doctor.

2. Stay away from things that start your asthma attacks (triggers).

3. Go to the doctor 2 or 3 times in a year for check-ups. Go even when you feel fine and have no breathing problems.

4. Know the signs to predict your asthma is getting worse and how to respond (consult your doctor).

Medications:

Most people with asthma need two kinds of medicine.

1. Quick-relief medicines (“relievers”) are used to stop asthma attacks.

2. Preventive medicines (“controllers”) are used every day to protect the lungs and keep asthma attacks from starting.

Now a days SMART therapy is available and both type of medicines are available in the same inhaler. Ask the doctor to write down what asthma medicines to take and when to take them.

The medicine plan provided by your doctor helps you :

• to know what quick-relief medicines to take when you have an asthma attack.

• to help remember what preventive medicines to take every day.

• to see if you should take asthma medicine just before sports or working hard.

It is important to stress that preventive medicines for asthma are safe to use every day.

• You do not become addicted to preventive medicines for asthma even if you use them for many years.

• Preventive medicine makes the swelling of the airways in the lungs go away.

The doctor may tell you to take preventive medicine every day:

• If you cough, wheeze, or have a tight chest more than twice a week

• If you wake up at night because of asthma

• If you have many asthma attacks

• If you have to use quick-relief medicine more than twice a week to stop asthma attacks.

Asthma medicine can be taken in different ways. When asthma medicine is breathed in, it goes right to the airways in the lungs where it is needed.

Inhalers for asthma come in many shapes. Most are sprays (Metered Dose Inhalers) and some use powder (Dry Powder Inhalers). A spacer or a holding chamber makes it easier to use a spray inhaler. Asthma medicine also comes as pills and syrups.

The important points which need to be stressed are that, always have asthma medicines, always keep a part of your monthly budget for your medicines and buy medicine well in advance before you run out of medicines. Always carry your quick-relief asthma medicine with you when you leave home.

Risk factors:

Many things can start asthma attacks. These things are called “ risk factors”: Animals ,Cigarette ,Smoke, Dust in beds with fur, Dust from Strong Pollen from the weather, sweeping smells and trees and sprays ,flowers ,Colds ,Running, sports, and working hard.

Different people with asthma respond to different risk factors. Know which ones start asthma attacks for you. Keep risk factors that start your asthma attacks out of your home.

The following are some household measures that could help the asthmatic patients.

• Many people with asthma are allergic to animals with fur. Keep animals outside. Give away pets.

• No smoking inside. Get help to quit smoking.

• Keep strong smells out of the home. No soap, shampoo, or lotion that smells like perfume. No incense. Make special changes to the room where the person with asthma sleeps.

• Take out rugs and carpets. They get dusty and moldy.

• Take out soft chairs, cushions and extra pillows. They collect dust.

• Do not let animals on the bed or in the bedroom.

• No smoking or strong smells in the bedroom.

•Keep the bed simple.

Dust collects in the mattress, blankets and pillows. This dust bothers most people with asthma.

• Put special dust-proof covers with zippers on the mattress and pillow.

• Do not use a pillow or a mattress made of straw.

• A simple sleeping mat may be better than a mattress.

• Wash sheets and blankets often in very hot water. Dry them in the sun.

Use windows to keep the air fresh and clean.

• Open windows wide when it is hot or stuffy, when there is smoke from cooking, and when there are strong smells.

• If you heat with wood or kerosene, keep a window open a little to get rid of fumes.

• Close windows when the air outside is full of exhaust from cars, pollution from factories, dust, or pollen from flowers and trees.

Plan to do these chores when the person with asthma is not there:

• Sweep, vacuum, or dust

• Paint

• Spray for insects

• Use strong cleaners

• Cook strong smelling foods.

• Air out the house before the person with asthma returns.

• If there is no one to help, people with asthma can use a mask or scarf when they sweep or dust.

Running, sports, or working hard can also cause asthma symptoms. But these activities are good for you and need not be stopped. Your doctor may tell you to take asthma medicine before doing these activities. Thus the quality of life need not be affected.

When you know there is asthma in the family, you may be able to keep your baby from getting asthma.

• When you are pregnant, do not smoke.

• Keep tobacco smoke away from the baby and out of your home.

• Put a special dust-proof cover on the baby’s mattress.

• Keep cats and other animals with fur out of your home.

Health check ups:

Go to the doctor 2 or 3 times a year for check- ups. Go even if you feel fine and have no breathing problems.

• Tell the doctor about any problems with your asthma medicines. The doctor can change the asthma medicine or change how much you take. There are many asthma medicines.

• Ask questions. Your doctor is your partner in controlling your asthma.

• Asthma may get better or it may get worse over the years. Your doctor may need to change your asthma medicines.

Know the signs that your asthma is getting worse and how to respond.

• Be alert for asthma symptoms: Cough, wheeze, tight chest and waking up at night. Act fast if an asthma attack starts.

• Move away from the risk factor that started the attack.

• Take a quick-relief asthma medicine.

• Stay calm for 1 hour to be sure breathing gets better.

Get emergency help from a doctor if you do not get better. Get help if you see any of these asthma danger signs.

• Your quick-relief medicine does not help for very long or it does not help at all. Breathing is still fast and hard.

• It is hard to talk.

• Lips or fingernails turn grey or blue.

• The nose opens wide when the person breathes.

• Skin is pulled in around the ribs and neck when the person breathes.

• The heartbeat or pulse is very fast.

• It is hard to walk.

Be careful! Using too much quick- relief medicine for asthma attacks can hurt you.

Quick-relief medicine for asthma makes you feel better for a little while. It may stop the attack. With some attacks, you may think you are getting better but the airways are getting more and more swollen. Then you are in danger of having a very bad asthma attack that could kill you. A bad asthma attack may be recognized;

• If you use quick-relief medicine more than twice a week to stop asthma attacks, this means you need a preventive medicine for asthma.

• If you need quick-relief medicine more than 4 times in 1 day to stop asthma attacks, you need help from a doctor today.

Monitoring asthma:

A peak flow meter can be used at a clinic or at home to measure how well a person is breathing.

• It helps the doctor decide if someone has asthma.

• It helps to see how bad an asthma attack is.

• It helps the doctor see how well asthma is controlled over time.

If a peak flow meter is used every day at home, people can find breathing problems even before they start to wheeze or cough. Then people know when more asthma medicine is needed. There are many kinds of peak flow meters (Consult your doctor for details on this).

Thus on this world asthma day let us all resolve to spread this awareness about asthma and let everyone know that "You Can Control Your Asthma".

The Pickwickian syndrome

2010-02-15T22:19:00.002+05:30

Today we look into an interesting syndrome in which obesity decreases ventilation!

The pickwickian syndrome, or obesity hypoventilation syndrome, was first described by Burwell and associates in 1956 and named for a character described in Charles Dickens' The Posthumous Papers of the Pickwick Club. Marked obesity, somnolence, cyanosis, periodic breathing, secondary erythrocytosis, and right ventricular heart failure were the initially described clinical characteristics of this syndrome.
Morbid obesity decreases total lung capacity (TLC), functional residual capacity (FRC), and tidal volume because of increased adipose tissue in the chest wall and elevation of the diaphragm caused by increased intra-abdominal adipose tissue. The reduced lung volumes lead to atelectasis, which alters ventilation-perfusion (V/Q) matching and causes hypoxia. There is also evidence that respiratory muscles become less effective in morbid obesity. Most patients also have OSA, which further increases ventilatory work in a system already predisposed to hypoventilation. Finally, hypoxic and hypercapnic responses are diminished in most patients, either secondary to chronic hypoxia and hypercapnia or, perhaps, congenitally. Even though the exact sequence of events is not always clear, it is easy to conceptualize that affected patients with reduced lung volumes, atelectasis, noncompliant chest walls, ineffective respiratory muscles, upper airway obstruction,and altered metabolic control of breathing are prone to develop hypoventilation, especially during sleep.

Treatment:
Nasal continuous positive airway pressure (nCPAP) is now clearly established as the most effective therapy for OSA. nCPAP is also effective in the majority of patients with obesity hypoventilation, not only resolving upper airway obstruction during sleep, but also increasing the ventilatory response to CO2 while awake and improving awake hypercapnia. However, there are many patients with severe OSA and hypercapnia who are only partially responsive to CPAP alone and continue to demonstrate sleep associated hypoventilation and elevated PaCO2 during wakefulness.

Yousaytoo Awards - a bit offtopic! to break the monotony.

2010-01-29T19:25:00.000+05:30

Friends today I am going a bit off topic in my bid to break the monotony and also put forward my optimistic side!
I am extremely glad to share information regarding the "yousaytoo awards". This award is given in the category of internet blogs. I am extremely hopeful and the optimism in myself comes to its its full bloom , the moment i think of a $1,000 holiday dream gift coming my way. It could be a clinic utility with which I could serve my patients.I being a Chest Physician a simple spirometer would be a dream gift for me which I could utilise for my patients. The fun gifts are really funny and the one that interests me the most is the digital photoframe keyring to put the keys of my two wheeler and carry my most memorable pics with me.I know that there are many competitors in the competition and my chances are a lot dependent on luck. Still I am an optimistic person and will continue to enrich my blog with some very useful sites that will definitely be resourceful to everyone.

Occupational Lung Diseases

2009-11-22T20:30:00.000+05:30

Friends today we will touch one of the very important aspects concerning the respiratory health -- The Occupational Lung Diseases!

There are various occupational lung diseases. Among them are: Asbestosis, a chronic, progressive inflammation of the lung; it is a consequence of prolonged exposure to large quantities of asbestos, a material once widely used in construction, insulation, and manufacturing. It is not contagious.
Black lung disease is the common name for coal workers' pneumoconiosis (CWP)or anthracosis, a lung disease of older workers in the coal industry, causedby inhalation, over many years, of small amounts of coal dust.
Silicosis is a progressive disease that belongs to a group of lung disorderscalled pneumoconioses. Silicosis is marked by the formation of lumps (nodules) and fibrous scar tissue in the lungs. It is the oldest known occupational lung disease, and is caused by exposure to inhaled particles of silica, mostlyfrom quartz in rocks, sand, and similar substances.
When asbestos is inhaled, fibers penetrate the breathing passages and irritate, fill, inflame, and scar lung tissue. In advanced asbestosis, the lungs shrink, stiffen, and become honeycombed (riddled with tiny holes).
Legislation has reduced use of asbestos in the United States, but workers whohandle automobile brake shoe linings, boiler insulation, ceiling acoustic tiles, electrical equipment, and fire-resistant materials are still exposed tothe substance. Asbestos is used in the production of paints and plastics. Significant amounts can be released into the atmosphere when old buildings or boats are razed or remodeled.
Asbestosis is most common in men over 40 who have worked in asbestos-relatedoccupations. Smokers or heavy drinkers have the greatest risk of developing this disease. Between 1968 and 1992, more than 10,000 Americans over the age of 15 died as a result of asbestosis. Nearly 25% of those who died lived in California or New Jersey, and most of them had worked in the construction or shipbuilding trades.
The risk of having black lung disease is directly related to the amount of dust inhaled over the years; the disease typically affects workers over age 50.Its common name comes from the fact that the inhalation of heavy deposits ofcoal dust makes miners lungs look black instead of a healthy pink. Althoughpeople who live in cities often have some black deposits in their lungs frompolluted air, coal miners have much more extensive deposits.
In the years since the federal government has regulated dust levels in coal mines, the number of cases of black lung disease has fallen sharply. Since theFederal Coal Mine Health and Safety Act of 1969, average dust levels have fallen from 8.0 mg. per cubic meter to the current standard of 2.0 mg. per cubic meter. The 1969 law also set up a black lung disability benefits program tocompensate coal miners who have been disabled by on-the-job dust exposure.
Despite the technology available to control the hazard, however, miners stillrun the risk of developing this lung disease. The risk is much lower today,however; fewer than 10% of coal miners have any x ray evidence of coal dust deposits. When there is such evidence, it often shows up as only small black spots less than 1 cm. in diameter, and may have been caused by smoking ratherthan coal dust. This condition is called "simple CWP" and does not lead to symptoms or disability.
It is estimated that there are 2 million workers in the United States employed in occupations at risk for the development of silicosis. These include miners, foundry workers, stonecutters, potters and ceramics workers, sandblasters, tunnel workers, and rock drillers. Silicosis is mostly found in adults over40. It has four forms:

Chronic silicosis may take 15 or more years ofexposure to develop. There is only mild impairment of lung functioning. Chronic silicosis may progress to more advanced forms.
Patients with complicated silicosis have noticeable shortness of breath, weight loss, and extensive formation of fibrous tissue (fibrosis) in the lungs. These patients areat risk for developing tuberculosis (TB).
Accelerated silicosis appears after 5-10 years of intense exposure. The symptoms are similar to those ofcomplicated silicosis. Patients in this group often develop rheumatoid arthritis and other autoimmune disorders.
Acute silicosis develops withinsix months to two years of intense exposure to silica. The patient loses a great deal of weight and is constantly short of breath. These patients are at severe risk of TB.

Occupational exposure is the most common cause of asbestosis, but the condition also strikes people who inhale asbestos fiber or who are exposed to wasteproducts from plants near their homes. Family members can develop the diseaseas a result of inhaling particles of asbestos dust that cling to workers' clothes.
It is rare for asbestosis to develop in anyone who hasn't been exposed to large amounts of asbestos on a regular basis for at least 10 years. Symptoms ofthe disease do not usually appear until 15-20 years after initial exposure toasbestos.
The first symptom of asbestosis is usually shortness of breath following exercise or other physical activity. The early stages of the disease are also characterized by a dry cough and a generalized feeling of illness.
As the disease progresses and lung damage increases, shortness of breath occurs even when the patient is at rest. Recurrent respiratory infections and coughing up blood are common. So is swelling of the feet, ankles, or hands. Other symptoms of advanced asbestosis include chest pain, hoarseness, and restless sleep. Patients who have asbestosis often have clubbed (widened and thickened) fingers. Other potential complications include heart failure, collapsed (deflated) lung, and pleurisy (inflammation of the membrane that protects thelung).
Since the particles of fine coal dust, which a miner breathes when he is in the mines, cannot be destroyed within the lungs or removed from them, builds up. Eventually, this build-up causes thickening and scarring, making the lungsless efficient in supplying oxygen to the blood.
The primary symptom of the disease is shortness of breath, which gradually gets worse as the disease progresses. In severe cases, the patient may developcor pulmonale, an enlargement and strain of the right side of the heart caused by chronic lung disease. This may eventually cause right-sided heart failure.
Some patients develop emphysema (a disease in which the tiny air sacs in thelungs become damaged, leading to shortness of breath, and respiratory and heart failure) as a complication of black lung disease. Others develop a severetype of black lung disease called progressive massive fibrosis, in which damage continues in the upper parts of the lungs even after exposure to the dusthas ended. Scientists aren't sure what causes this serious complication. Somethink that it may be due to the breathing of a mixture of coal and silica dust that is found in certain mines. Silica is far more likely to lead to scarring than coal dust alone.
The precise mechanism that triggers the development of silicosis is still unclear. What is known is that particles of silica dust get trapped in the tinysacs (alveoli) in the lungs where air exchange takes place. White blood cellscalled macrophages in the alveoli ingest the silica and die. The resulting inflammation attracts other macrophages to the region. The nodule forms when the immune system forms fibrous tissue to seal off the reactive area. The disease process may stop at this point, or speed up and destroy large areas of the lung. The fibrosis may continue even after the worker is no longer exposedto silica.
Early symptoms of silicosis include shortness of breath after exercising anda harsh, dry cough. Patients may have more trouble breathing and cough up blood as the disease progresses. Congestive heart failure can give their nails abluish tint. Patients with advanced silicosis may have trouble sleeping andexperience chest pain, hoarseness, and loss of appetite. Silicosis patients are at high risk for TB, and should be checked for the disease during the doctor's examination.
Screening of at-risk workers can reveal lung inflammation and lesions characteristic of asbestosis. Patients' medical histories can identify occupations,hobbies, or other situations likely to involve exposure to asbestos fibers.
X rays can show shadows or spots on the lungs or an indistinct or shaggy outline of the heart that suggests the presence of asbestosis. Blood tests are used to measure concentrations of oxygen and carbon dioxide. Pulmonary functiontests can be used to assess a patient's ability to inhale and exhale, and acomputed tomography scan (CT) of the lungs can show flat, raised patches associated with advanced asbestosis.
Black lung disease can be diagnosed by checking a patient's history for exposure to coal dust, followed by a chest x-ray to discover if the characteristicspots in the lungs caused by coal dust are present. A pulmonary function test may aid in diagnosis.
X rays can detect black lung disease before it causes any symptoms. If exposure to the dust is stopped at that point, progression of the disease may be prevented.
Diagnosis of silicosis is based on:

A detailed occupational history.
Chest x rays will usually show small round opaque areas in chronic silicosis. The round areas are larger in complicated and accelerated silicosis.
Bronchoscopy.
Lung function tests.

It should be noted that the severity of the patient's symptoms does not always correlate with x-ray findings or lung function test results.
The goal of treatment is to help patients breathe more easily, prevent coldsand other respiratory infections, and control complications associated with advanced disease. Ultrasonic, cool-mist humidifiers or controlled coughing canloosen bronchial secretions.
Regular exercise helps maintain and improve lung capacity. Although temporarybed rest may be recommended, patients are encouraged to resume their regularactivities as soon as they can.
Antibiotics may be prescribed to combat infection. Aspirin or acetominophen (Tylenol) can relieve minor discomfort and bronchodilators that are swallowed or inhaled can relax and widen breathing passages.
Diuretics (drugs that increase urine production and excretion) or digitalis glycoside (Digitalis purpurea) are prescribed for some patients. Othersmay need to use supplemental oxygen or use less salt.
Anyone who develops symptoms of asbestosis should see a family physician or lung disease specialist. A doctor should be notified if someone who has been diagnosed with asbestosis:

Coughs up blood
Continues to lose weight
Is short of breath
Has chest pain
Develops asudden fever of 101°F (38.3°C) or higher
Develops unfamiliar, unexplained symptoms.

There is no treatment or cure for black lung disease, although it is possibleto treat complications such as lung infections and cor pulmonale. Further exposure to coal dust must be stopped.
Likewise, there is no cure for silicosis. Therapy is intended to relieve symptoms, treat complications, and prevent respiratory infections. It includes careful monitoring for signs of TB. Respiratory symptoms may be treated with bronchodilators, increased fluid intake, steam inhalation, and physical therapy. Patients with severe breathing difficulties may be given oxygen therapy orplaced on a mechanical ventilator. Acute silicosis may progress to complete respiratory failure. Heart-lung transplants are the only hope for some patients.
Patients with silicosis should call their doctor for any of the following symptoms:

Tiredness or mental confusion
Continued weight loss
Coughing up blood
Fever, chest pain, breathlessness, or new unexplained symptoms.

Patients with silicosis should be advised to quit smoking, prevent infections by avoiding crowds and persons with colds or similar infections, andreceive vaccinations against influenza and pneumonia. They should be encouraged to increase their exercise capacity by keeping up regular activity, and tolearn to pace themselves with their daily routine.
Asbestosis can't be cured, but its symptoms can be controlled. Doctors don'tknow why the health of some patients deteriorates and the condition of othersremain the same, but believe the difference may be due to varying exposuresof asbestos. People with asbestosis who smoke, particularly those who smoke more than one pack of cigarettes each day, are at increased risk for developing lung cancer and should be strongly advised to quit smoking.
Those miners with simple CWP can lead a normal life. However, patients who develop black lung disease at an early age, or who have progressive massive fibrosis, have a higher risk of premature death.
Silicosis is currently incurable. The prognosis for patients with chronic silicosis is generally good. Acute silicosis, however, may progress rapidly to respiratory failure and death.
Workers in asbestosis-related industries should have regular x rays to determine whether their lungs are healthy. A person whose lung x ray shows a shadowshould eliminate asbestos exposure even if no symptoms of the condition haveappeared.

Anyone who works with asbestos should wear a protective mask or a hood with aclean-air supply and obey recommended procedures to control asbestos dust. Anyone who is at risk of developing asbestosis should:

Not smoke
Be vaccinated against influenza and pneumonia
Exercise regularlyto maintain cardiopulmonary fitness
Avoid crowds and people who haverespiratory infections.

A person who has asbestosis should exercise regularly, relax, and conserve energy whenever necessary.
The only way to prevent black lung disease is to avoid long-term exposure tocoal dust. Coal mines may help prevent the condition by lowering coal dust levels and providing protective clothes to coal miners.
Silicosis is a preventable disease. Preventive occupational safety measures include:

Controls to minimize workplace exposure to silica dust
Substitution of substances--especially in sandblasting--that are less hazardous than silica
Clear identification of dangerous areas in the workplace
Informing workers about the dangers of overexposure to silica dust, training them in safety techniques, and giving them appropriate protectiveclothing and equipment.

Coworkers of anyone diagnosed with silicosis should be examined for symptomsof the disease. The state health department and the Occupational Safety and Health Administration (OSHA) or the Mine Safety and Health Administration (MSHA) must be notified whenever a diagnosis of silicosis is confirmed.

ref:

http://www.faqs.org/

Hurricane hits Mumbai, India- does it have any implications?

2009-11-12T20:17:00.001+05:30

So why are we discussing it here?
Well the reason is that there's a relationship of hurricanes with Asthma!

Hurricanes do have an affect on asthma patients, and the 2005 hurricane season has gotten off to a busy start.
In 1992, after Hurricane Floyd, the CDC established a link between hurricanes and an increase in asthma severity.
After a hurricane there is increased particle matter in the air, there is no electricity and an increase in mold grow months afterward.
While cleaning up debris, asthma patients should use a mask that fits securely over the mouth and nose. If at anytime during the cleanup an asthma patient starts to feel short of breath, begins to cough or experiences chest tightness, the asthma patient needs to sit down and rest immediately. Asthmatics may need to find another way to aid in the cleanup besides digging through debris.
With electricity out, possibly for days, asthma patients need to make sure they have a battery operated nebulizer. If they do not, asthma patients who use a nebulizer on a regular basis to control asthma symptoms need to check with their doctor or local hospital.
After a hurricane, mold will grow. Make sure all standing water, wet carpet, wet ceilings, etc. are dried thoroughly. If wet carpet, ceilings, furniture, etc. are not replaced immediately make sure these items as well as others are monitored closely for mold growth.
Hurricanes are part of our weather. With hurricanes comes an increase in possible triggers for asthmatics.

source:
http://www.asthmanow.com/

Exercise & Sports in Asthma

2009-11-08T19:31:00.000+05:30

Having asthma does not mean that you cannot exercise. However, if you have any limitations in your ability to exercise because of your asthma, your asthma is not being controlled properly.

If your asthma is not controlled and you exercise, you may experience worsening symptoms. If this it the case, you need to take steps to first regain total asthma control prior to resuming your exercise program. The inability to exercise without symptoms is a sign of poor asthma control. Talk to your doctor about this. Once you have total control, you will be able to exercise without asthma symptoms.

If your asthma is under control and you experience asthma symptoms five or 10 minutes after exercising, this is probably due to exercise-induced asthma.

Exercise-induced asthma occurs because the airways are sensitive to temperature and humidity changes, especially when breathing in cold, dry air through the mouth. Air that passes through the mouth is bypassing the nose, which normally humidifies and warms the air prior to its reaching the lungs.

The diagnosis of exercise-induced asthma is made by performing a breathing test (spirometry) at rest and then again following exercise. If there is a measured decrease in the speed of air that can be breathed out following exercise, this indicates exercise-induced asthma, or EIA, is present.

Contributing factors to exercise-induced asthma include:

How long you exercise
How hot or cold it is
How humid it is
Whether allergens, air pollution or other possible triggers are present while you exercise
It's important to note that the benefits of regular exercise almost always outweigh the risks associated with exercise-induced asthma.

These benefits include:

Improved efficiency of the heart and lungs
Increased muscle strength and endurance
Improved flexibility and posture
Improved ability to relax
If you're unsure whether your symptoms are due to exercise induced asthma, or are the signs of worsening asthma control, talk to your doctor.

Once you and your doctor have established what your exercise regimen should be, keep the following in mind:

Take your medication before starting to exercise if advised.
Start your regimen slowly. Take your time before attempting more demanding exercises.
Always warm up before exercising, and cool down after.
If you develop symptoms while you are exercising, stop and rest. Take your reliever medication.
If you usually exercise outdoors and it's cold out, opt for indoor exercise.
If you usually exercise outdoors and the pollution or pollen counts are high, exercise indoors instead.

source:
http://www.asthma.ca/

Laughter-induced asthma: It’s no joke

2009-11-08T18:55:00.000+05:30

More than half of people with asthma report that their symptoms are brought on by laughter, according to a study to be presented at the American Thoracic Society International Conference on May 24.

The study of 235 patients with asthma found that 56% had laughter-induced asthma (LIA). Asthma that is triggered by laughter doesn’t seem to cause more asthma flare-ups requiring emergency room visits or hospitalizations compared with other types of asthma, according to study author Stuart Garay, M.D., Clinical Professor of Medicine at NYU Medical Center in New York. "But patients did report that during times when their asthma is well controlled they can laugh for longer without getting asthma symptoms. That suggests that laughter-induced asthma may be a sign that a person’s asthma isn’t as well controlled as it could be. People with asthma should be allowed to laugh."

Nobody knows how laughter brings on asthma, but it might involve hyperventilating, Dr. Garay said. He noted that exercise was the only trigger more common in people with laughter-induced asthma compared with asthma not induced by laughter (61% of people with LIA vs. 35% of asthma patients without LIA).

Dr. Garay was struck by how common laughter-induced asthma is. "It’s as common as some of the most well-known asthma triggers, such as grasses, trees, pollen, fumes and odors, and it’s even more common than dust mites, allergy to animals and molds," he said. "It’s a little-appreciated frequent trigger."

The study found that the most common symptom in patients with laughter-induced asthma was coughing, which generally starts within two minutes. The next most common symptom was chest tightness.

How much laughter can set off breathing problems? "It depends on the patient," Dr. Garay said. "For a majority of patients, mild laughter or even a chuckle will set off coughing. For others, laughing hard will bring on asthma symptoms."

Source: EurekAlert!
Further information: www.thoracic.org/

Vaccination Helps Guard Against Swine Flu

2009-11-06T21:59:00.002+05:30

The World Health Organisation has cautioned people to continue to protect themselves against swine flu and vaccination may greatly help in this exercise.

"At the WHO we remain quite concerned about the pattern we are seeing, particularly because a sizeable number of people do develop serious complications and death," said Keiji Fukuda, special adviser on pandemic.

"Again, we are seeing most of this develop in people who are younger than 65 years, a picture which is different from seasonal influenza," he explained.

Fukuda reiterated that the cases of serious complications were largely found among the chronically ill, pregnant women as well as some otherwise healthy younger people.

He also countered signs of public scepticism about the vaccine revealed by surveys in several countries, despite the resurgence of swine flu in the northern hemisphere with the onset of the colder season.

"WHO believes that these vaccines are very useful against the pandemic virus," Fukuda said in a telephone news conference.

Vaccination against A(H1N1) influenza has now started in more than 20 countries and were demonstrably safe, according to the WHO.

"What we are seeing is that these vaccines are highly safe and have been received by a significant number of people without any problems," Fukuda said.

Swine flu has differed from seasonal flu in persisting in the northern hemisphere during the summer period and in a pattern of occasional serious illness affecting under 65-year-olds.

However, Fukuda acknowledged that it was as transmissible as seasonal flu, showed the same pattern of spreading more widely in winter and was "self limiting" in that the large majority of people who caught it got better without the need for special treatment.

More than 5,700 people have died worldwide since the pandemic

virus was first discovered in April, with most deaths 4,175 reported in the Americas region, according to WHO data.

source:

http://www.medindia.net/news/

Attack Asthma learn more. Here are the Asthma triggers!

2009-11-06T21:52:00.001+05:30

Triggers in Your Home

Mold

Mold grows on damp things such as shower curtains, bath items, tubs, basins and tiles.

What you can do?

If you see mold, clean it up with soap and water.
Use exhaust fans or open a window in the bathroom when showering and the kitchen when cooking or washing dishes.
Fix leaky plumbing or other sources of water as soon as possible.
Dry damp or wet items within 1-2 days to avoid mold growth.

Dust Mites

Dust mites are tiny bugs you can’t see. They live in sheets, blankets, pillows, mattresses, soft furniture, carpets, and stuffed toys, such as stuffed animals.

What you can do?

Wash bed sheets and blankets once a week. Dry completely.
Use dust-proof covers on pillows and mattresses.
Vacuum carpets, rugs and furniture often.
Wash stuffed toys. Dry completely.

Secondhand Smoke

Asthma can be triggered by the smoke from the burning end of a cigarette, pipe, or cigar, or the smoke breathed out by a smoker. Choose not to smoke in your home or car, and don't allow others to do so either.

What you can do?

Don’t smoke in your home or car.
Don’t let anyone smoke near your child.
Pledge to make your home and car smoke-free

Cockroaches

Cockroach body parts and droppings may trigger asthma attacks.

What you can do?

Keep counters, sinks, tables, and floors clean.
Clean dishes, crumbs, and spills.
Store food in air tight containers.
Cover trash cans.

Cats and Dogs

A warm-blooded animal's urine and saliva may also trigger attacks.

What you can do?

Keep pets outside if possible.
If you have a pet inside, keep them out of the bedroom and off the furniture.
Vacuum carpets and furniture often.

Nitrogen Dioxide

Nitrogen dioxide is an odorless gas that can irritate your eyes, nose, and throat and may cause shortness of breath. This gas can come from the use of appliances that burn fuels, such as gas, wood, and kerosene.

What you can do?

If possible, use fuel-burning appliances that are vented outside. Always follow the manufacturer's instructions on how to use these appliances.
Gas cooking stoves: Never use these to keep you warm or heat your house. If you have an exhaust fan, use it when you cook.
Unvented kerosene or gas space heaters: Use the proper fuel and keep the heater adjusted the right way. Open a window slightly or use an exhaust fan.
Wood stoves: Make sure the doors are tight fitting. Follow the maker's instructions for starting, burning, and putting out the fire.
Fireplaces: Always open the flue.

Chemical Irritants

Chemical irritants found in some products in your house, such as scented or unscented products, including cleaners, paints, adhesives, pesticides, cosmetics, or air fresheners, may make your child's asthma worse.

What you can do?

Use these products less often and make sure your child is not around when you use the products. Also, consider trying different products.
Take great care to follow the instructions on the label. If you use these products, try to make sure that windows or doors are open and that you use an exhaust fan.

Source:
http://www.noattacks.org/triggers.html

Create Better Breathing Space for Asthmatics

2009-11-06T21:49:00.000+05:30

Quick Tips

Ventilation is crucial.

"The building of tightly-sealed houses over the last two decades has made it much easier for moisture and dust to collect in homes," Harvard professor Dr. Douglas Dockery notes. Many vapors trapped indoors, from perfumes and air fresheners to formaldehyde from particleboard, irritate asthmatics. When it’s fresh or even cold outside, keep windows open a crack to circulate air. On hot days, close windows and use air conditioners to ventilate and filter out smog.

Don’t harbor dust mites.

Microscopic dust mites and their droppings are a potent allergen and asthma trigger. One of the best ways to limit the amount of dust mites in your homes are to encase mattresses with impermeable covers.

Eradicate cockroaches and keep clutter to a minimum.

Piles of dirty clothes make a growth environment for mildews and mites; piles of paper attract cockroaches. Remember, you can eliminate household pests without using toxic pesticides.

Maintain humidity below 50 percent.

"Dehumidifying is enormously important, as many asthmatics are highly allergic to mildews and molds," says Harriet Burge, Ph.D., associate professor at Harvard School of Public Health.

Minimize pet dander.

"Cat dander is everywhere, even if you wash the cat," Centers for Disease Control Dr. Ruth Etzel says. "The only real solution is not to have the cat." Or, wash every two to three weeks, Los Angeles pediatrician Harvey Karp advises.

No cigarette smoking in the home or car, or anywhere in asthmatics’ presence.

Furnace and heating duct filters should be replaced periodically as they collect dust and molds. Some businesses provide duct-cleaning services.

Keep asthmatics away from gas stoves.

"Open the oven door and you get a blast of NO2," says University of British Columbia professor emeritus Dr. David Bates. "The asthmatic child should not sit in the kitchen doing homework if the oven is being used." Make sure that stoves are well-ventilated, too.

Ask your pediatrician about allergenic foods.

If there is a family tendency to allergy, Dr. Ruth Etzel from the Centers for Disease Control says, parents might limit foods associated with allergies, such as cow’s milk, from the child’s diet in the first two years. She and other pediatricians recommend that mothers try to breastfeed their infants for at least the first year.

Check your local air quality index daily.

Asthmatic children should not exert themselves outside in hot, smoggy weather, or when a dusty wind blows; smog counts tend to be highest between 3pm and 6pm. Air Now, a site provided by the U.S. Environmental Protection Agency, allows you to check your local air quality, get ozone maps and more.
Try air cleaning and purifying machines.

Consumer Reports says a good air cleaner can help those allergic to dust and mold spores, citing the fan/filter models as most effective in removing airborne dust. The machine will help most in the asthmatic’s bedroom; but keep it at least six feet from the bed (it creates draft), and don’t place on carpet (it can kick up dust). But, "They can only help if you’ve gotten rid of the risk factors first, like dust mites, mold and danders," Harvard School of Public Health associate professor Dr. Harriet Burge warns. Warning: many asthmatics experience irritation from the ozone type of air purifier.

101 Hints, Tips and Bits of Wisdom from President Ronald Reagan’s Allergist

2009-11-06T21:45:00.003+05:30

Timely Help For People With Allergies And Asthma

President’s Ronald Reagan's former allergist, Ralph Bookman, M.D., has earned the respect of doctors and patients by developing effective ways to minimize allergy problems. He is an ‘old school’ scholar with a tremendous amount of valuable information for allergy sufferers.

While Governor of California, Ronald Reagan came looking for Dr. Bookman for some allergy relief. Ronald Reagan liked what he saw With Dr. Bookman it’s not hard to like, what you see is what you get.

"The practice of allergy has become overly complicated and complex, says Dr. Bookman. It’s essentially a very simple subject, and unfortunately, some of its most effective treatments have been all but forgotten".

Here, then, are a number of those treatments, tips, explanations and opinions culled from a series of interviews and from Dr. Bookman’s excellent book, The Dimensions of Clinical Allergy (Charles C. Thomas, publisher; 1985).

An associate clinical professor at the University of Southern California School of Medicine and a member of the Advisory Council of the National Institute of Allergy and Infectious Diseases, Dr. Bookman still makes his own allergy extracts and still dispenses his highly opinionated advice to a select group of patients — including the former President — four days a week.

We’re extremely pleased to be able to bring you this small sample of Dr. Bookman’s wisdom as a special treat.

1. Thresholds

"Even when people are allergic to a substance, there is a certain level they can tolerate before symptoms will appear. Exceed that ‘threshold’ and up pop the symptoms".

"Most people already understand that the same amount of pollen can bother one allergic person and not another. What they often fail to understand is that thresholds can also vary widely in the same person from one day to the next".

2. Nobody ‘Outgrows’ Allergies

"The lifetime of the allergic individual is one in which symptoms will wax and wane in intensity and shift from one part of the body to another. This shifting of symptoms is poorly understood and leads many people to mistakenly believe that one can ‘outgrow’ their allergy symptoms".

3. Example: Eczema

"An example is the child with a severe case of incredibly itchy eczema who suddenly improves without apparent reason".

"The most recent symptom of the child’s allergic nature — the eczema — has disappeared, but it is invariably replaced by another allergy symptom. In most children, the shift is from eczema to nasal symptoms".

"But the parents and physician are generally so relieved that the eczema is gone that they don’t even notice the runny, stuffed-up nose that wasn’t there before!"

4. Irritants, Not Allergens

"A large number of non-protein substances like Kleenex, paper dust, paint fumes, perfume, newsprint and cigarette smoke are erroneously called allergens, but they’re not. They do produce symptoms in many people, but it’s because they’re irritating, not allergic".

5. Bake Your Paper

"Newsprint is a problem for some people because of irritative solvents in the ink. Problems only occur with freshly printed papers and can be avoided simply by putting new papers into an oven set on very low heat for around 20 minutes or so".

6. Growing Up Allergic

"An infant’s first exposure to proteins is primarily through foods, which is why food allergies are so common in allergic infants. As the infant grows, his ‘protein world’ expands, and he begins to react to the indoor allergens he’s inhaling".

"Exposure to pollen generally comes later, which is why outdoor allergies rarely appear in children before the age of 3. As the child grows older, the food allergies so common to infants gradually disappear — only to be replaced by inhalant allergies".

"The food allergies weren’t outgrown — they were replaced!"

7. Positive Reactions Not Positive Proof

"The first thing that happens when an allergic person inhales, ingests or physically contacts an allergen is that they become ‘sensitized’ to it. All that means is that their body now recognizes that substance distinctly — it doesn’t mean that exposure is going to cause them to experience symptoms".

"But it will cause them to react to that substance when skin tested. These positive reactions tend to convince people that they’re allergic to many more things than they really are".

8. To Understand Allergy, Look Beyond The Symptoms.

"In medical school you learn to look for the cause of a disease based upon the location of its symptoms. But allergy is not a disease — it’s an inherited condition that cannot be understood from the medical school point of view".

"It doesn’t matter if the symptoms show up in the nose, chest, eyes, ears, skin or somewhere else — the problem isn’t in that one area. Allergy is a lifelong condition that affects the entire individual".

9. Where’s Your ‘Dial’ Set Today?

"Generally these changes occur gradually during a person’s lifetime. Without changing a thing around them, some people’s sensitivities to one substance can all but vanish, while other allergies will reappear after years of absence".

"I like to say that the ‘dial setting’ of their allergic responsiveness has changed. Most times, this occurs slowly and subtly, but some events can cause immediate changes in a person’s ‘dial setting’".

10. Shots And Sickness Work The Same

"Allergy injections don’t get rid of your allergy to a substance — they raise your threshold, so that you can tolerate more of the substance before you experience symptoms".

"But a virus will have almost the same effect, temporarily. It’s not unusual to see allergic skin lesions clear or respiratory symptoms disappear during a virus attack. Surgery or a major trauma, such as breaking a bone, almost invariably shuts down allergy symptoms as well".

11. Allergy Symptoms: There Are Only Three

"When you do exceed your threshold, symptoms appear. All allergic symptoms are a combination of three basic effects, and nothing more".

"There is edema (swelling), particularly of the skin and mucus membrane. There is an increase in the secretion of mucus, especially in the respiratory tract. And there is spasm of smooth muscle where smooth muscle exists".

12. Swelling Tops The List

"Edema is the most common result of an allergic reaction, but the actual symptoms it produces depend entirely upon the area where the swelling occurs. In the upper respiratory tract, for instance, swelling can cause nasal obstruction or sinus obstruction, close the ear’s Eustachian tube, or cut off a person’s sense of smell by obstructing their olfactory recess".

"Edema near the larynx causes ‘allergic hoarseness.’ In the trachea it leads to an irritating cough. In the bronchial tree it causes asthma".

13. The Most Serious Edema

"If you’re lucky enough to have your allergic edema show up in the nose, you can always breathe through your mouth. But when the same edema is experienced in the bronchial tree, there aren’t any breathing alternatives".

"That, in a nutshell, is why asthma is so serious".

14. Eczema? Just Abused Edema

"The only allergic response the skin can have is edema. It doesn’t have smooth muscle and it can’t secrete mucus".

"Atopic dermatitis — or eczema — always begins as simple edema. But most doctors never see the swelling that occurs at the beginning of the condition because the intense itching (caused by the stretching of the skin) makes people tear away at the area and really scratch it up".

15. Smoke: Not Allergic

"A lot of people claim to be allergic to tobacco smoke, but the large molecules necessary for an allergic reaction can’t survive the burning heat of a cigarette".

"There are cases of true tobacco allergy, but they always involve physical contact with the raw leaf. Cigarette smoke can make you cough, sneeze and wheeze, but it’s not an allergy and allergy treatments won’t prevent it or clear it up".

16. Alcohol Augments Allergies

"Alcohol is also not an allergen. But it does act to congest the nasal passages. In someone with allergic rhinitis (a runny, stuffed-up allergic nose) it adds to the edema already present due to allergies".

"Some people with allergies are unable to drink at all because of the intense nasal congestion that alcohol produces. I sometimes wonder if a lot of hangovers aren’t the result of alcohol-induced sinus blockage".

17. Allergies And Emotions

"It has been a tedious burden to have to constantly explain that emotions have no effect whatsoever on allergy symptoms — especially to people who are absolutely convinced this is true because they read it somewhere or heard it on TV. I am far more impressed by the effect that allergy symptoms have on a person’s emotional state. People who think that allergic symptoms are the result of emotional problems obviously have the cart before the horse! A nose that’s blocked up constantly day and night can’t help but cause a person to be irritable and lessen their ability to cope with life and its daily problems".

18. Pollen Alone?

"Probably Not . . ".

"Close questioning of patients who insist that they only have seasonal complaints invariably reveals that most of them are not completely symptom-free the rest of the year. Their year-round symptoms may be minor — occasional sneezing, a productive cough, some slight nasal stuffiness — but they are there if you look for them".

"These people obtain much more relief when they’re treated for both their year-round (indoor) allergies and pollens than when treated for pollens alone".

19. Too Much Dander And Nothing Works!

"The amount of dander deposited on a home’s rugs and furniture by a pet is usually far greater than allergy injections can overcome. The shots won’t help until the pets are moved outside and the dander has been cleaned out of the rugs and furniture".

20. Skin Test Tips

"You can’t predict the severity of a person’s symptoms by their skin tests alone. I often see large skin test reactions in people with mild hay fever and small reactions in people who have severe allergy problems. And not all people with allergic disease react when skin tested. Occasionally you’ll see a person with a classic history of spring hay fever whose skin tests are negative. Such people generally respond well to injections of the pollens that are in the air when their symptoms are worst".

21. Seniors Can Be Skin Tested

"Some doctors claim that elderly people don’t react at all when skin tested. This is just not so. Older people tend not to flare (the redness that appears around a positive skin test), but the wheal (the actual hive-like welt that springs up when a test is positive) can be read if you look at it in oblique light and feel around to determine its size".

22. When Not To Test

"It’s pretty much useless to skin-test someone when their asthma symptoms are severe or when they’re recovering from surgery or other trauma. Just as these conditions temporarily relieve allergy symptoms, they also shut down skin test responses. If you want to really learn what you’re allergic to, wait till you feel better".

23. Bad Marks In History

"Taking a person’s history accurately is more important in allergy practice than in any other medical specialty. Many people’s allergies go undiagnosed simply because most doctors don’t ask enough questions, don’t know the right ones to ask and don’t know which answers actually point to a diagnosis of allergy".

24. Medical Forms Miss The Mark

"Forms interfere with getting a good idea of a person’s medical history for two reasons. First, they’re created by doctors, using terms that doctors are familiar with but that many patients aren’t. You get a lot of wrong answers simply because most people are going to misunderstand at least some of the words on the form. Second, all forms, no matter how carefully they are written, are extremely rigid in structure. This prevents a doctor from learning of unusual events that may be important for correct diagnosis".

25. Doctors: Ask More Questions!"

"A doctor should always ask a patient what they mean when they say they ‘have a lot of colds’ or when they complain of frequent infections. Are these really infections, or just short-term worsening of the person’s allergic symptoms? Most doctors think that the only allergy symptom is sneezing, and if you don't sneeze you don't have allergies. People in cold climates will often report having lots of colds and infections in the winter. The real problem is that they’re spending more time indoors — surrounded by indoor allergens".

26. How To Catch A Mouth Breather"

Don’t bother asking people if they’re mouth breathers, because they’re just going to say no. Ask them instead if they wake up with a dry mouth or a sore throat in the morning — both are sure signs of mouth breathing! Hot drinks will relieve the problem quickly".

27. Not All Seasonal Allergies Are Pollen

"Steer manure, a popular springtime lawn fertilizer, contains copious amounts of cattle dander, which is a very potent allergen. Because it’s generally only applied in the spring or fall, people often mistake the seasonal symptoms as an allergy to pollens".

28. If The Plant Is Pretty, Don’t Worry

"Many people tend to look at a colorful field of flowers as a producer of airborne pollen. But those bright colors are there to attract insects, which carry the heavy pollen from plant to plant. In most cases it’s safe to say that flowers whose blossoms are easily visible and colorful are insect pollinated and won’t cause problems".

29. Pets — Or Pollen?

"Cats and dogs that are allowed to roam often play in grassy and weed-strewn areas, where they can pick up quite a bit of pollen in their pelts. The only allergen in cat saliva is dander. Cats are always licking themselves and their saliva is heavily contaminated with the skin scales they’re licking off! Some people who think they’re allergic to pets are actually reacting to the pet borne pollen and not to the pet".

30. Minor League Symptoms Can Cause Major League Fatigue

"Constant low-grade allergy symptoms can often be more detrimental than symptoms that are severe, but occasional. Constant, annoying symptoms can really wear away at a person’s sense of well-being. They can destroy their ability to get a good night’s sleep or concentrate at work".

31. Goat Hair? In The White House?

"Most people have a lot more animal dander in their environment than they realize. If they have a true Oriental rug, for instance — one actually made in the Orient — then it is certainly loaded with sheep, goat and camel dander. President Reagan tells me he feels much better when he’s at Camp David than at the White House, and I’m not surprised. The White House is full of antique furniture stuffed with animal hair. When someone plops down in one of those old chairs or overstuffed couches, a ton of dander comes blowing into the room. Camp David has all new furniture. And new furniture isn’t filled with dander".

32. Wool Worries

"Good quality domestic wool is processed to be dander-free; it is not allergenic. However, it is irritating to many people — and not just those with allergies. Wool from third-world countries is not treated after it’s taken from the animal. This kind of wool can contain a lot of dander and cause serious allergy problems".

33. Outdoor Pets Are No Problem

"Pets that remain outdoors at all times can be dismissed as an allergy problem. In fact, the pet itself isn’t the problem at all — it’s the dander that saturates the carpets and furniture, especially in the bedroom, that causes constant, annoying symptoms. But be warned — removing a pet won’t show benefits for a long time; you have to get rid of the leftover dander first. Vacuuming the carpet daily for a month will remove it, and the room will remain dander free as long as the pet never enters again".

34. Women’s Mucus

"Women are often relieved to hear that it is not unusual for vaginal mucus discharge to increase when traditional allergy symptoms are most troublesome. This is especially true of seasonal allergy reactions, and it’s a perfectly normal allergy symptom".

35. Is All Asthma Allergic?

"Almost everyone in the medical community looks at bronchial asthma and allergic rhinitis (hay fever) as separate and distinct entities. I look at them both as manifestations of respiratory allergy. After all, the same mucus membrane lines the respiratory tract from top to bottom, and the changes that occur in the nose and sinus in allergy are virtually identical to the changes that occur in the bronchial tree during an asthma attack. When you look at the similarities of the conditions instead of their differences, I think you can treat the patient better".

36. ‘Sudden Onset Allergies’ Were Always There

"A lot of people will claim that their allergy symptoms have suddenly appeared after a lifetime without allergies. In almost every case, careful questioning will reveal that allergy symptoms may have been minimal and tolerable, but were certainly there in the past. This is important because true allergy doesn’t just suddenly appear".

37. ‘Frequent Colds’ Are Frequently Allergies

"Physicians’ offices are filled with patients complaining of frequent colds. It is unfortunate that these people’s symptoms aren’t recognized for what they are: allergic rhinitis that would respond well to specific allergy care. I’ve had patients tell me that they only have two colds a year. But when I question them, I find out that the first ‘cold’ tends to last as long as the spring pollen season, while the second coincides perfectly with the fall pollen season!"

38. Cold Or Allergy?

"A cold is an upper respiratory infection, and it displays the typical symptoms of infection: low grade fever, purulent nasal discharge and a general malaise that lasts from 3 to 5 days. It also has a tendency to be transmitted from one family member to another. Continuous episodes of sneezing with a watery nasal discharge, nasal obstruction and head congestion accompanied by a sense of fatigue that lingers for weeks or longer can be reasonably assumed to be allergic".

39. A Little Swelling Can Make A Big Impact

"Several areas adjacent to the respiratory tract have one thing in common: They’re so small that very little edema (swelling) is necessary to obstruct them. These include the middle ear and the olfactory recess, which controls our sense of smell. When episodes of sinus pain, middle ear problems and loss of sense of smell occur, look to allergy as the cause".

40. Sinus Infections? Open Up The Nose!

"Sinus obstruction is a common result of edema in this crowded area. When the obstruction blocks the mucus flow completely, the stagnant mucus becomes a breeding ground for bacteria. As soon as the obstruction is removed (by a combination of allergy therapy and decongestants), the mucus flow is restored and the condition quickly resolves itself".

41. Allergic Deafness

"This is a condition frequently seen in children and, less often, in adults. Fluctuations in the deafness are a clear signal that allergies may well be the cause. The problem is due to sporadic edema of the middle and inner ear. Children who go through varying periods of inattentiveness and withdrawal are often experiencing this intermittent allergic deafness".

42. All Septums Are Deviated!

"No biological entity has a body part that is ruler-straight, therefore no one has a perfectly straight septum! They all deviate from the vertical to some degree. The only effect of a deviated septum is to make one nasal passage larger and the other smaller. There is no real effect on total airflow. When swelling occurs, the smaller one will quite naturally block before the larger one, but the final effect on airflow is the same as if both sides were equal".

43. Leave It Bent

"I see little reason in most cases to straighten septums, and the temporary improvement you see after straightening is the same allergy-deadening effect you can expect from any surgery. The swelling and obstruction generally return in a few weeks — after your body recovers from the trauma of the surgery".

44. That Stuck-in-the-Throat Feeling

"Some people with postnasal drip will develop swelling in an area of the throat called the uvula. Because this area has little sensory discrimination, the swelling feels as if there’s mucus trapped there that can’t be dislodged. Drinking ice water will reduce the swelling and eliminate that feeling of trapped mucus".

45. Allergic Hoarseness

"Many people with allergies often experience a painless hoarseness. Look down their throat and you’ll find swelling and pallor rather than the red, ‘angry,’ painful inflammation caused by overuse. Using an epinephrine inhaler (like Primatene Mist) eliminates the edema causing the problem. People who use their voice professionally — singers, actors, announcers, and yes, even the President — often experience gratifying results when they use such an inhaler before speaking or singing. But it won’t help if the problem is non-allergic and just due to overuse".

46. Allergic Vertigo

"The term ‘Meniere’s Syndrome’ refers to a poorly understood condition where the patient suffers from recurrent or chronic vertigo (dizziness). You can’t say that the condition is due exclusively to allergy — there are many other causes. But when upper respiratory allergy symptoms are also present, there’s a chance that allergy therapy designed to affect the nose and chest may also ease the vertigo".

47. Antihistamine Advice

"If there were one or two reliable antihistamines that worked for everyone, the rest would evaporate and be forgotten. But that, of course, is not the case — their effectiveness and side effects are different in everyone. Patients should be given small starter packs so they can find the antihistamine that works best for them. They should also avoid driving until they are certain of how drowsy a specific antihistamine makes them. Some produce such a powerful sedation that they may help an allergic patient not so much by controlling their symptoms, but simply by helping them get a good night’s sleep!"

48. And A Warning. . . . . .

"Antihistamines function well in allergy partly because of their drying effect. But in asthma, the reverse — hydration — is necessary for the control of symptoms. Therefore, antihistamines should never — I repeat, never — be used when asthma symptoms are present. I prefer to use decongestants instead".

49. Decongestant Dependence

"There is no question that it is possible to get ‘hooked’ on a nasal decongestant. ‘Addicted’ patients generally have a spray at home, one in the car, one in the office and one in their pocket or purse that they use every hour or so. These are the people most at risk of the ‘rebound’ effect. There is always some ‘rebound’ in the form of nasal swelling with the use of these products, but for most people, the effect is barely noticeable. Abusers, however, can experience severe swelling as the area becomes irritated from constant use of the drug".

50. The ‘Cold Turkey’ Cure

"Such people must take a 72-hour break from decongestants. It’s a trying experience for many of them, but almost all will experience significant relief when the rebound swelling and obstruction subside. People with true allergic rhinitis can avoid abuse by limiting themselves to a single daily spray or by using decongestant drops at nighttime. At other times they should rely on antihistamines".

51. Instant ‘Allergic Ear’ Relief!

"Eustachian tube block can often be dramatically relieved with nasal sprays containing a strong decongestant, such as Neo-Synephrine (0.5 percent). Tilt the head back and to one side, turn the spray bottle upside-down and get enough of the spray into the nasal passage so that you can actually taste some of it in the back of your throat. Then turn your head the other way and repeat, using the other nostril. This technique is often dramatically effective at ending allergic ear problems, because it passes the decongestant directly over the entrance to the Eustachian area located in the nasopharynx. During plane flights, this should be done one-half hour before a scheduled descent. For children, it should be done at the first sign of pain or discomfort, repeated in 4 hours and then repeated again if symptoms reappear. This will often abort painful episodes of otitis media. Drinking more fluids on a regular basis will greatly reduce the unnecessary use of antibiotics.

52. Tissues, Not Allergies, Shred Noses

"Red, raw and chafed noses are thought by many to be a sign that allergies are present. They may be, but the actual chafing damage is invariably due to the excessive use of paper tissues. All tissues are made of wood pulp and are extremely irritating. "Children often suffer heavily fissured, even infected, noses because mothers, in their zeal, insert the tissue into the nostril and twist vigorously. "The condition is easily cured by using handkerchiefs or other cotton cloths and greasing the nostrils with Vaseline".

53. Nasal Bleeding

"Streaks of blood mingled with nasal mucus are a common occurrence. Medical texts and some physicians warn that such bleeding can be due to malignancy, but I have never encountered such a case. So far, it’s always been due to trauma caused by fingernails. "Children admit this habit, although adults rarely will. The proof in either case is that you can generally see the abrasions on the inside of the nostril after the bleeding stops".

54. Allergic Styes

"Occasionally, people with allergies will develop recurrent styes that are attributed to their condition. "The real cause of the infection that has developed in the irritated hair follicles of their eyelashes is constant itching and rubbing. Treat the allergy and the eye symptoms will clear".

55. Wash Your Hands To Prevent Eye Problems!

"The skin of the fingers is notoriously resistant to allergy reactions, but the thin skin around the eyelids is extremely reactive. And the area of our body most often touched with the finger is the area around the eye. "Washing hands immediately after handling pets, foods and other problem substances can greatly reduce eye symptoms in allergic individuals".

56. Asthma? See An Allergist!

"Asthmatics treated by a good allergist are hospitalized much less frequently than those under the care of other types of physicians. That’s because all asthma is allergic. If more physicians realized this, asthma would be treated much more efficiently in this country".

57. Moderate Asthma The Worst

"It’s the person with low-grade, moderate asthma who benefits the most-from competent medical help. These people suffer constant low-level wheezing and shortness of breath that makes them irritable, miserable and tired all the time. "I believe that the additional muscular effort each breath takes for these people is a very common cause of fatigue".

58. Prescription: 40 Winks!

"The difficulty some of these people have in coping with life is due entirely to the fatigue their condition is causing. Nothing produces a more positive response in such people than allergy therapy that allows them to get a good night’s sleep".

59. A Slap On The Back For Nighttime Panic

"A somewhat rare but extremely frightening event can occur with asthmatic children at night: They awaken terrified and unable to breathe. If someone strikes them sharply on the back, however, they will cough and almost immediately begin to breathe again. "The explanation is relatively simple. The child has developed a large mucus plug that has been loosened by a cough but is so large that it becomes stuck in the trachea and obstructs their breathing. The slap on the back dislodges it so that it can be coughed up and swallowed harmlessly".

60. How To Fight Frequent Infections

"Many asthmatics are treated for long periods of time with antibiotics, generally in response to the appearance of grossly purulent sputum. "Almost all of these infections are due to dehydration and can be easily prevented. Fluids will loosen the bronchial secretions, and this almost always results in dramatic improvement. Antibiotics should be used only when necessary".

61. Improve A Cough To Relieve Fatigue

"Asthma basically consists of swelling and hyper-secretion of mucus inside the bronchial tree. Coughing is the most effective way to dislodge and raise thick mucus, but an ‘ineffective cough’ that requires a lot of energy can be exhausting. "The physician’s primary obligation in asthma is to improve a tight, rasping, ineffective cough until you can hear the rumbling, rattling sound of a productive one. This frequently relieves chronic fatigue".

62. Keep Your Cough Awake

"Don’t ever suppress a cough with antihistamines or codeine. You need to be aware of the need to cough and you need to be able to cough productively. You don’t ever want to relax that cough reflex. It will improve with better hydration and allergy treatment, and a productive cough will cease when there is nothing left to produce".

63. Liquids Are Medications!

"Unquestionably, the single most important element in the treatment of asthma and other bronchial allergy symptoms is hydration. Unless adequate fluids are available to the mucus glands in the bronchial tree, their secretions will be tenaciously hard to raise. In asthma, liquids are medications. They are a prerequisite for any other medications to be effective".

64. 10 Glasses A Day!

"Liquids make mucus liquid. They change it from a troublesome solid that makes breathing difficult to an easy to cough up liquid. I demand that my patients drink 10 full glasses of liquid every day, and I question them constantly to make sure they understand how important it is. "Lack of fluids will lead to chronic fatigue, irritation — even family problems. "

65. Any Fluid Will Do!

"Yes, I’m forceful about my patients getting fluids! I’ve been doing the same damn thing for so many years with good results that I see no reason to be flexible now! They can drink anything they want. Water is best, of course, but I tell them to drink what they like: iced tea, soda — Jell-O is basically water. Any fluids will work but you must make a fetish of it".

66. Women Are The Worst!

"Women as a group are especially bad at this — they just don’t drink enough fluids! I lecture them about the dire effects of dehydration and get real dramatic about it — I have to! Some of them actually have to be harassed into it! But they soon learn that fluids are the best way to help a productive cough accomplish its purpose".

67. Inhaler Tips

"Over-the-counter (nonprescription) inhalers that contain epinephrine can be a tremendous help for people with asthma. There are a lot of ‘new’ inhaled medications for asthma on the market today, but I find that epinephrine alone provides excellent relief. It’s often the best medication to help get a good night’s sleep. "But danger lies in the abuse of these products. Taken too frequently, they can have a drying effect on the bronchial tree. They must be used sparingly. In addition, epinephrine will be practically useless for the dehydrated asthmatic. The drug cannot provide relief if the bronchial mucus is all dried out. But it will provide excellent relief after the patient has been rehydrated".

68. The Most Common — And Least Treated — Allergy Symptom

"The cough is the single most common symptom encountered in the practice of medicine, yet precious little consideration is ever given to its origin or treatment. The overwhelming majority of coughs are allergic or irritative in nature. The allergic ones are productive coughs trying to clear mucus. Irritation produces a nonproductive cough, and both are major causes of fatigue".

69. That’s Right — Fatigue

"All coughs require muscular effort, and fatigue is the inevitable consequence of continued coughing. When the cough is severe enough, the fatigue will be accompanied by irritability and emotional problems. A severe cough can disrupt the tranquility of almost any home. "But remember — it’s important not to suppress a productive cough, because it is productive. It’s removing mucus plugs that must not remain where they are".

70. The ‘Hack’ Of Irritation

"The irritative, nonproductive cough has a ‘hacking’ quality and is generally in response to some form of irritation in the throat. The most common cause in allergic individuals is irritation caused by mouth breathing and postnasal drip. "This tends to get worse at night simply because the drip increases when you lie down. The condition improves greatly when you sit up, and many people with the problem simply sleep sitting up".

71. Morning Cough The Most Productive

"Since the cough reflex generally shuts down during sleep, a large amount of mucus can accumulate in the bronchial tree. This explains the morning cough that many people with allergies and asthma experience. The morning cough serves to ‘uncork’ much of the mucus obstructing the bronchial tree, and the result is a significant improvement in breathing".

72. Severe Irritative Cough

"A severe, sometimes explosive, cough that originates in the larynx or the trachea is almost always due to allergic swelling of the area — especially if traditional cough suppressants such as codeine provide no relief. "Not surprisingly, it typically responds well to an epinephrine inhaler, whose only effect is to relieve such swelling".

73. If It Don’t Itch, It Ain’t Eczema

"A rash that doesn’t itch enough to keep you awake at night is not atopic dermatitis, whose hallmark is exquisitely intense itching. More likely, such a rash is an indication of a drug reaction and will vanish when you stop taking the drug that caused it".

74. To Stop The Itch

"Two factors increase the itching in atopic dermatitis — exposure to the air and the presence of crusts and scales. The best treatment attends to both factors. "Soaking in a tub filled with a handful of Epsom salts dissolved in comfortably warm bath water for 15 to 20 minutes several times a day will remove crusts and scales. Ocean bathing can achieve the same result. Open lesions may sting a bit at first, but relief will come rapidly. "After the bath, get dry and immediately apply boric acid ointment. In children, use Vaseline instead. It may seem messy, but it will greatly reduce itching by protecting the skin from exposure to the air. "If the grease appears to inflame the skin further, use a water-soluble ointment like Aquaphor instead".

75. Antihistamines And Long Sleeves

"Sedatives should be used cautiously in eczema, as they may actually make the itching worse. Antihistamines not only control the itch, but their side effect of drowsiness can help people with the condition get a good night’s sleep without scratching. "Children with eczema should wear long sleeves and long pants day and night. This reduces exposure to the air and offers some protection against scratching, especially during sleep".

76. Habit Scratching

"Even after successful allergy therapy many patients will continue to scratch out of habit. Keeping the area well lubricated with Vaseline and covering it with an elastic bandage will disrupt the habit and allow the area to heal".

77. Could ‘Chronic Hives’ Be Bug Bites?

"I find it odd that so many pediatricians and dermatologists report seeing patients with chronic hives when I’ve never encountered such a person. I have seen the persistent itchy little bumps these physicians describe, but they are invariably the result of insect bites. "Their appearance on the legs is a strong clue that the culprit is fleas. These little creatures are tenaciously hard to eliminate from the home and rarely jump higher than 18 inches to bite their prey.

78. Hives Or Bites?

"Hives are generally widespread, affecting almost all of the body at-once. Insect bites tend to be confined to limited areas, such as the legs, and appear in isolated clusters".

79. Bee Careful When Swimming!

"The most common location where people are stung today is in swimming pools. The bee falls in the water, the swimmer brushes up against it, and the bee does what comes naturally".

80. Bee Sting: When To Worry

As long as the reaction to the sting remains close to the actual area stung, there is no need for concern. But hives, nasal symptoms or asthma are the alarming signals of bee sting allergy. People who have so reacted must carry emergency epinephrine and know how to use it".

81. Allergic Headache

"It is unfortunate that this common allergy symptom receives so little attention, since it responds to treatment more readily and more successfully than any other form of recurrent head pain. "So-called ‘cluster headaches’ that appear in the spring and fall are inevitably allergic responses to pollen. Indoor allergens are also a common headache cause".

82. Migraine? — Or Allergy?

"Both allergic and migraine headaches tend to appear early in life. Migraines, however, decrease in intensity as one gets older. Allergic headaches do not. And while migraines have a classic, distinctive appearance, allergic headache is characterized by the total absence of any specific pattern. Pain can occur anywhere in the head".

83. Head Pain? How’s Your Nose?

"There is a strong association between head pain and nasal congestion in allergic individuals. Many notice that their head pain is relieved at the same time as their congestion. Others notice considerable nasal discharge or a ‘bubbling’ noise in the head as their headache improves, strongly suggesting that a sinus obstruction has been relieved".

84. Pass On Pillows For Headache Relief

"Of 75 headache patients I tested, all but a very few were found to be strongly allergic to environmental (indoor) allergens. "A few ended their headaches with such simple environmental controls as removal of a down comforter, feather pillows or a pet. One patient’s head pain was relieved by the removal of a bedroom chair found to contain goat hair".

85. A Positive Mistake

"Sometimes a person will inadvertently receive an injection that is too strong during allergy therapy. The headache that quickly develops is the final diagnostic proof that their headaches are allergic in origin and that the correct allergen is being used. "Many patients will also note that their headaches return if they wait too long between injections".

86. Pack Your Nose For Head Pain!

"When head pain is definitely caused by blocked sinuses, there is a technique that brings quick relief. Saturate tufted cotton with a strong nasal decongestant, pack as much into each nostril as the person can tolerate, using a twisting motion, and leave it there for 5 minutes. "There’s often dramatic relief of the pain, especially if you catch the headache early on. You can’t do it more than once a day or it’ll be too irritating, and you have to use tufted cotton in order to hold enough of the decongestant fluid. Q-Tips won’t do the job".

87. Kids: Teach Fluids Early

"Fluids are even more important in young children. Try to get them used to drinking fluids when they’re free of any symptoms. Young children will always balk at forcing fluids when they don’t feel well".

88. The Shot Glass Solution

"If you ask a child to just ‘take a sip’ from a full glass, they know you really want to get them to finish it. But you can easily ‘trick’ them into drinking more fluids than the full glass contains by giving them the liquid in a whiskey shot glass and repeating it every 10 or 15 minutes. No child has a problem drinking that small an amount, and they’ll do it frequently".

89. Allergy Treatment Improves Personality!

"Parents tend to take their child’s stuffy nose and constant sneezing for granted, but these chronic symptoms have a marked impact on a child’s personality and their ability to perform well in school. "After successful allergy therapy, parents and teachers often comment on how much brighter and less irritable the child has become".

90. Down Or Dog, It’s Still All Dander

"In all reactions to animals, only the dander is significant. The hairs and feathers have no allergic potential themselves, but are always contaminated by dander, which is nothing more than an animal’s old skin scales. "Each feather, if examined carefully, will show the presence of dried dander at its base. This dander will remain despite commercial cleaning, which is why ‘down’ can be highly allergenic even when old".

91. Puppys No Problem

"Very young animals have no old skin to shed, and therefore have no dander. It usually takes a couple of months before such pets produce their allergen, which may explain why some people ‘suddenly’ become allergic to a dog or cat they got as a pup or kitten".

92. Pet Myths Myth The Point

"Legend has it that poodles don’t cause allergy problems. The fact is that they may have less dander to give off because they are the breed that is washed and groomed the most frequently. "Likewise, Chihuahuas are thought to be a ‘safe’ pet because they are hairless. But hair is not the problem! It probably just takes a long time for such a small dog to give off sufficient quantities of dander to put a person over their allergic threshold".

93 . Fun Fur No Fun

"Rabbit, when used as a ‘fun fur’ or in an angora sweater, can be a source of allergy symptoms because the fur is too delicate to clean all the dander out. "Most other costume furs are ‘dander free, but contact allergy symptoms sometimes develop from the lacquer used to color the fur".

94. Mow A Wet lawn

"Mowing the lawn, frequently a symptom-producing chore, can be made safer by wetting the lawn first to keep pollen and molds from flying around. It does make the job more difficult, but truly allergic souls won’t mind if it prevents their symptoms".

95 . Olive Tree Not Too Pretty . . .

"The olive tree, commonly found in the western states, can produce intense allergic reactions during the first four or five weeks of spring. It produces a lot of heavy pollen, most of which stays close to the tree. "Since it is often used as a decorative tree around homes, allergic people would do well to identify such trees and keep that side of their house closed up during its pollinating season. Hosing the tree down daily is also helpful".

96. Allergy Relief Begins In The Bedroom

"Since we spend half our lives in the bedroom, this is the area where controls will be the most effective. "Of course the living room contains allergens! But the short time that we spend there generally doesn’t justify the expense and inconvenience necessary to remedy its faults. "Time and energy spent in allergy proofing the bedroom, however, will be well returned in reduced symptoms".

97. Pillow Power

"All pillows must be synthetic. I’ve found Dacron to be the most comfortable substitute for feather pillows. "Forget allergy encasings. They don’t work well on pillows unless the zipper is airtight, and that makes the pillow like a balloon, since the air can’t escape".

98. Blanket Protection

"Wool blankets are not only irritating, they’re notorious dust collectors. Turn off the lights in the bedroom, shine a flashlight across the bed and slap down on the blanket with your free hand. You’ll probably see a very convincing cloud of dust. "Synthetic blankets should be used since they don’t collect dust as readily. Down comforters, of course, must be removed".

99. Forego Furnishings

"Overstuffed furniture should be removed from the bedroom. Analysis has found cattle dander, goat hair and burlap, which contains highly allergenic hemp and jute, in such furniture".

100. Rugs Are Okay — Just Not On The Floor!

"Rugs hanging on walls for decoration are harmless, even if they are ‘real’ Orientals laden with goat and camel hair. Symptoms only occur when allergens are kicked up as rugs and furniture are disturbed — not when they just hang on a wall".

101. Victory Through Ventilation

"Many patients observe that they feel bad in the morning, but not until they get out of bed and start moving around. "That’s because dust has settled during the night and they only react when it’s disturbed. High efficiency filtration of incoming fresh air and of recirculating air can help lessen exposure to allergens".

Spiderman, Superman to help kids understand diseases, treatments

2009-11-06T21:27:00.000+05:30

London: A pair of health experts has produced a series of superhero comics to educate children about diseases and their treatments.
Dr. Kate Hersov joined forces with fellow medic Dr Kim Chilman-Blair to create Medikidz.
She made this decision after a 12-year-old patient asked for help understanding his newly diagnosed leukaemia.
She says that she was growing increasingly frustrated by what she perceives as a worrying lack of child-focused information.
"He said 'I can hardly pronounce it, let alone understand it," she said.

"Often when we made a diagnosis of a young child we felt helpless that we had nothing to give the child themselves to understand what we had just told them," she added.
Kate said that it was out of their "frustration as clinicians" that she and Dr. Chilman-Blair created Medikidz.
"We knew children needed a place to go to understand the medicine, whether that be the diagnosis, medicines or treatment procedures," she said.
The 'Medikidz' are a gang of five larger-than-life superheroes, designed to educate children through a wide range of media.
One element is an interactive website featuring a virtual world of the human body which the child can explore, and the opportunity to create their own avatar (virtual identity) to talk to other children about their condition.
"Parents sometimes feel that children are too young to understand medical concepts, or that they are better off not knowing," Dr. Chilman-Blair said.
"The Medikidz programme wants to change this view.
"We don't sugar-coat serious problems; we provide clear and factual information in a way that is easy to understand and engaging to read.
"We want the children who use Medikidz to be in control of their illness," Dr. Chilman-Blair added.
The two doctors have plans to cover 300 paediatric conditions, but have launched this week with the first ten-including Type 1 diabetes, epilepsy, leukaemia and asthma.
In the asthma comic book, the newly diagnosed Max Bond is taken on a tour of his lungs, while the superheroes Chi, Skinderella, Gastronomic, Pump and Axon explain how and why his lungs malfunction and the drugs that can be used to help.
Kim Gillberg, health promotion manager at Asthma UK, believes that this project may offer a valuable tool to help children.
"It's important that children and young people are given options in the way they access health information and we fully support the use of engaging and interactive materials," she said.
"The essential thing is that the information provided is accurate, positive and empowers children and young people to be able to manage long-term medical conditions, such as asthma, effectively," she added.
All the comic books are peer reviewed and have input from play specialists, nurses and often charities.
Though the first editions would be aimed at the 10-15 age group, there are plans for a storyboard format for younger children also.
It’s a great job for humanity.
Source: Agencies

Air pollution and your lungs

2009-11-02T21:51:00.000+05:30

The air we breathe can be harmful to our lungs. This page looks at some of the dangers of air pollution, and gives some suggestions for how you can help tackle the problem.

Is air pollution a problem?

Everyone has a right to clean air. Despite this, millions of tons of harmful gases and particles are released into the air each year. Some of this pollution reaches our lungs with every breath we take.
The black smoke emitted from many diesel engines is one obvious form of air pollution. Many other types of pollution can't be seen but are just as damaging to our health.
Forty years ago coal burning was responsible for most pollution in our cities. The infamous London smog of 1952 resulted in an extra 4,000premature deaths. Today, thanks to smokeless fuels, taller chimney stacks and reductions inindustrial emissions, our cities are relatively free of smoke.
That doesn't mean air pollution has disappeared. Power stations, factories, offices and even our homes all help pollute the air we breathe. Motor vehicles are a major source of air pollution, both in towns and in the country.
One in every five people is particularly at risk from air pollution. People who already have a lung disease, the elderly and children are likely to be especially affected by high levels of pollutants.

Which pollutants cause the problems?

Smoke
The majority of city smoke comes from diesel exhausts. In some areas coal burning or electrical generating power stations make up a significant proportion of total smoke.
Large smoke particles are trapped in the upper airways (nose to voicebox), but smaller particles (PM10s) may travel deeper into the lungs.
High levels of PM10s cause increased breathing difficulties in people with asthma, COPD and other lung conditions. They may also causepremature death in older people with heart and lung disease. For this reason, PM10s are now thought to be the most important of the
common air pollutants.
Sulphur dioxide (SO2)
Sulphur dioxide (SO2 ) is produced by power stations and diesel engines. SO2 and smoke produced by coal burning were responsible for the high death rates during the London smog of 1952. Although levels have fallen, SO2 is still a potential health problem in some parts of Britain. Its main effect is on the lungs where it makes the airways narrow. This makes breathing difficult, particularly for people with asthma and young children.
Nitrogen dioxide (NO2)
Nitrogen dioxide (NO2 ) is one of the chemicals produced when fuel is burnt in power stations and cars. NO2irritates the lining of the airways. Together with other pollutants, the levels of NO2 found close to busy roads may have a bad affect on some people with asthma.
Ozone (O3)
Ozone (O3 ) is the main ingredient of modern smog. In Britain ozone levels are highest during hot summers. Ozone irritates the lungs, causing coughing and chest pain. It also stings the eyes, nose and throat. People with lung diseases are particularly at risk, but up to a third of normal healthy people may develop symptoms when they exercise outdoors. This can lead to a decrease in their athletic performance.
Carbon monoxide (CO)
Carbon monoxide (CO) is an odourless, poisonous gas that comes mainly from traffic exhaust. It stops the blood carrying oxygen to the brain, heart and other tissues. People with heart disease are particularly at risk. Cigarette smoke is a big source of carbon monoxide; smokers have much higher levels in their blood than non-smokers.

Lead
Lead is bad for the normal development of children. Lead levels are falling but lead in petrol still accounts for 80% of lead in air.
Acid air
Acid air happens during modern smog when NO2 and SO2 are converted into acids; particularly nitric and sulphuric acid. These form into tiny clouds of acid droplets. It is this 'acid air' which eventually falls as acid rain, damaging plants and trees. We can breathe in fine particles of acid. This causes irritation of the airways, coughing and sometimes wheezing.

How can I protect myself against air pollution?

If you are exposed to urban pollution for any length of time you should think about protecting your lungs with a mask. Good masks keep out large particles. People with asthma and others with breathing difficulties may find this makes the air they breathe less irritating. Masks also show motorists how concerned you are about air pollution.
In the UK, advice on levels of air pollutants is available at www.airquality.co.uk. Where levels of air pollutants are high, if you are affected you should spend less time outside, particularly in city streets.
If your asthma is affected by air pollution, follow the treatment plan that you normally use when your condition gets worse.

What can you do about air pollution?

Cars are a major source of air pollution in our cities. In 2006 there were 33.4 million licensed motor vehicles in Britain. By the year 2025 there could be 50 million. You can cut down on some pollution if you use unleaded petrol and drive a car with a catalytic converter. If your vehicle uses diesel, be sure to buy ultra clean diesel.
Or drive less - use public transport when you can. If the public transport service in your area is poor, write and tell your local authority why you are adding to air pollution.
If air pollution is to be controlled we need to adopt strict air quality standards for all the main pollutants. And we need to monitor the quality of the air we breathe. Ask your local authority if they measure the pollutants mentioned in this leaflet.

source:
http://www.lunguk.org/

World Pneumonia Day

2009-11-02T13:28:00.005+05:30

November 2, 2009 will mark the first annual World Pneumonia Day to mobilize efforts to fight a neglected disease that kills more than two million children under age five every year. This global event will help bring this health crisis to the public’s attention and will encourage advocates, donors and policy makers alike to take action to combat the disease.

The Disease- Pneumonia

What is pneumonia?

Pneumonia is an infection of the lungs.
It causes cough and fever and can make breathing difficult.
Severe pneumonia can be deadly.

Who is most at risk?

In most developing countries, children under 5 and especially under 2 years of age are at risk.
The elderly are also at risk.
Tobacco smoke and other indoor air pollution can also increase chances of being more susceptible to pneumonia.
Some children and adults are at greater risk because they have other illnesses, such as AIDS. People with AIDS stand a much greater chance of dying from pneumonia.
Children who are poorly nourished can also have weakened immune systems, putting them at higher risk.

What causes pneumonia?

Many organisms can cause pneumonia.
Globally, bacteria such as Hib and pneumococcus are estimated to cause more than 50% of pneumonia deaths in children under 5 years of age.
Viruses and fungi can also cause pneumonia infections.
The Solution

Pneumonia is a problem with solutions

More than ever before, we now know how to protect and prevent children from catching pneumonia, and how to treat those suffering with this illness.
Every 15 seconds, pneumonia kills another child. That’s 5,500 child deaths every day, and a staggering 2 million child deaths every year from a preventable, treatable disease.
Now is the time to put knowledge into action to deliver these solutions to all children around the world.

We can protect from pneumonia

Exclusive breastfeeding during the first six months of life is an important and easy way to help protect children from pneumonia and many other diseases.
Other strategies, like good nutrition for older children, hand-washing, and reducing indoor air pollution from cook stoves and tobacco smoke, can also help protect children from pneumonia.
Preventing pneumonia before it occurs is key

Vaccines are a safe and effective tool for preventing pneumonia before it occurs.
Vaccines against two of the main causes of life-threatening pneumonia – pneumococcus (Streptococcus pneumoniae) and Hib (Haemophilus influenzae b) – are used throughout the developed world.
However, millions of children in developing countries still lack access to them.
Measles and pertussis (ie. whooping cough) vaccines can prevent infections that can lead to pneumonia as a complication.
Children should have access to effective and affordable treatment

The treatment for most types of serious pneumonia is usually antibiotics, which typically cost less than one dollar per dose.
Tragically, only an estimated 1 of every 5 children with pneumonia receives antibiotics.
Effective “case management” strategies can help to ensure that children receive the right treatment for pneumonia quickly, even in the poorest communities.

Prevent

Preventing pneumonia before it occurs is key

Pneumococcal and Hib vaccines

Vaccines are a safe and effective tool for preventing pneumonia before children get sick.
Hib and pneumococcal bacteria are estimated to cause more than 50% of life-threatening pneumonia in children under five.
Pneumococcal conjugate vaccines are used throughout most of the developed world to protect children from pneumococcal pneumonia. Yet most children in developing countries don’t yet have access to this vaccine.
Hib (Haemophilus influenzae type b) is another common cause of serious pneumonia. Used routinely for nearly 20 years in developed countries, Hib vaccine is being used today in more countries than ever before to prevent pneumonia cases caused by this deadly bacterium.
Within two years, 98% of children in low-income countries could have access to Hib vaccine in their country’s routine immunization program.Yet, the percent of children actually receiving vaccine is still low in many places, particularly hard-to-reach rural areas.
Through the focused efforts of countries, partners, suppliers and donors, children in the poorest countries will soon have access to the newest generation of pneumococcal vaccines.
Urgent action is needed to deliver life-saving Hib and pneumococcal vaccines to all children. Every year of delay is hundreds of thousands of lives.

Measles and pertussis vaccines

Some diseases, like measles and pertussis (whooping cough), can lead to pneumonia as a complication.
Safe and effective vaccines against measles and pertussis are used throughout most of the world.
Improving immunization coverage within developing countries should be an imperative to ensure that each and every child receives these vaccines.

Preventing HIV and other diseases in children can help reduce risk of pneumonia

HIV is a disease that can weaken children’s immune systems, making it more likely for them to develop diseases like pneumonia.
Other diseases such as malaria and influenza can also increase a child’s risk of developing pneumonia.
We can prevent HIV from being passed from mother to child with appropriate medications and counseling.

Preventive antibiotic therapy for people with HIV

Cotrimoxazole is a medication that can help prevent pneumonia in people with HIV.
All HIV-positive children, as well as children born to mothers with HIV, should receive cotrimoxazole.

Zinc supplementation

Zinc is an important micronutrient that has been found to prevent child pneumonia and reduce the risk of death from pneumonia.
Undernourished children may need inexpensive zinc supplements to make up for lack of zinc in their diets.
Zinc supplementation can reduce that rate of pneumonia in children by 14 to 25%.

Protect

Protecting children from pneumonia is possible

Exclusive breastfeeding

Breast milk is an excellent source of nutrition for babies.
Exclusive breastfeeding during the first six months of life is one of the best ways to protect children from pneumonia and many other diseases.
Exclusive breastfeeding can reduce the rate of pneumonia among young infants by 15 to 23%.

Adequate nutrition

It is critically important that all children receive good nutrition.
Undernourished children are at higher risk for illness and death. In fact, lack of proper nutrition may contribute to more than 1 million deaths from pneumonia yearly.
Malnutrition weakens children’s immune systems.It also weakens their muscles, making it more difficult to cough and breathe if they become sick with pneumonia..

Reduce low birth weight

Babies born with a low birth weight are at risk for pneumonia, other health problems and even death.
Low birth weight is related to the health and nutritional status of mothers.
Improving prenatal care for expecting mothers can help to reduce the number of babies born with a low birth weight. Babies born at low birth weight need appropriate care to reduce their risk of illness or death.

Reduce indoor air pollution

Indoor air pollution may be caused by many different sources, including cigarette smoking and the burning of biofuels for cooking and home heating.
Reducing indoor air pollution can help to protect children from pneumonia and other respiratory diseases.

Hand washing

Hand washing can help to reduce the spread of germs and disease.
This is a simple and inexpensive way to help protect children from pneumonia.

Treat

Treatment for pneumonia works, and it is affordable

Case management

Case management involves correctly diagnosing and treating pneumonia.
It is a critical part of efforts to reduce pneumonia deaths.
Effective case management requires trained and skilled health workers; strong referral and communication systems; and health facilities equipped with antibiotics, oxygen and guidelines for pneumonia management.

Community health workers

Many families, particularly those living in poor and rural communities, lack access to basic medical care for their children.
Community health workers can save children’s lives by diagnosing and treating pneumonia, and referring to a health facility if needed.

Techniques for diagnosis

In developed countries, health workers use tools, like chest x-rays and lab tests, to diagnose pneumonia.
In developing countries, health workers often lack these tools, and must instead rely on symptoms and signs to make a diagnosis.
By counting a child’s breaths during 1 minute, and checking for other important pneumonia symptoms, health workers can make a diagnosis of pneumonia so that children can receive appropriate treatment quickly.

Antibiotics

The treatment for pneumonia is a prompt, full course of antibiotics.
Antibiotics are very inexpensive, costing less than a dollar per dose.
Tragically, only an estimated 1 of every 5 children with signs of pneumonia receives life-saving antibiotics.
If pneumonia worsens and lungs fill with puss, a child may have to undergo painful and risky surgery to survive.

Oxygen therapy

Children who are very sick with pneumonia often have difficulty breathing in the oxygen their bodies need. A low level of oxygen is a common and potentially deadly complication of pneumonia.
With existing technology, health workers can place a simple, safe device on a child’s finger to measure their oxygen levels.
Many hospitals in developing countries are not equipped with the tools needed to check oxygen levels in sick children, and oxygen is often not available.
There are now machines that purify regular air into oxygen. These can then be used to treat patients with low oxygen levels, and are cheaper in the long run than other sources of oxygen.
Access to these simple, cost-effective tools in hospitals and health centres in developing countries can reduce the rate of pneumonia deaths by as much as 35%.

Now is the time to take action to deliver these life-saving solutions to all children and give children a chance for a better life.

Source:
www.worldpneumoniaday.org

Wanna quit smoking?

2009-10-30T19:52:00.001+05:30

Smoking cessation guide for patients

Did you know Tuberculosis affects many parts of the body?

2009-10-26T19:28:00.002+05:30