25 September, World Lung Day (WLD),is a day for lung health encouragement and exploit a prospect for all to unite and endorse better lung health worldwide. People are suffering respiratory infections from a very long period and will remain to be a foremost cause of human suffering and death.

Virus, bacteria, fungi and other organisms can infect respiratory system and cause infections which interfere the normal breathing causing common cold, sinusitis, pharyngitis, epiglottitis, laryngotracheitis, bronchitis, pneumonia, etc. Pneumonia is the leading cause of death in children and in the elderly. Nearly 80 percent of deaths are in children under 2 years and adults above 65 years.  Majority of demises occur in low and middle-income nations.

Every year approximately there are 10 million new patients of  Tuberculosis (TB) and 1.5 million deaths. Deaths from TB happen typically in children below 5 years and adults in the 20-35 year age array. Above 95 % of TB deaths happen in low – and middle-income nations. COVID-19 is one among viral respiratory infection that has posh over 25 million people in the world and approximately 860,000 have expired by the start of September 2020.

Patients experience persistent respiratory symptoms

The burden is likely to increase exponentially in the near future. Apart from the initial morbidity and mortality, recently long term consequences are also being increasingly recognized. The degree and cruelty of the long term respiratory problems of covid-19 infection remain to be seen, but evolving statistics specify that many patients experience tenacious respiratory signs for months their initial illness. As per a recent study, 3-months after discharge, residual abnormalities of pulmonary function were observed in 25.45% of the cohort, mostly demonstrated diffusion reductions in DLCO.

It is necessary to follow up these patients, performing comprehensive assessment and early rehabilitation exercise for detection and appropriate management of any persistent or emerging long-term sequelae of COVID-19. Pulmonary rehabilitation takes a central seat in the management of post Covid lung fibrosis and is available only at handful of centres across the city.

Pulmonary rehabilitation (PR) has proved helpful in reducing symptom, physiological and psychosocial for chronic respiratory patients. It is a standard of care alongside other well-established treatments (such as pharmacotherapy, supplemental oxygen, or noninvasive ventilation) for patients with a chronic respiratory disease.

Patients with a chronic respiratory disease.

Case 1: Mr. Ajay (Name changed) a 69 years old gentleman, diagnosed with Covid-19 was medically managed for 16 days and discharged from the hospital with continuous oxygen support of 4 litres/minute. Since he was on supplementary Oxygen support and was dependent on his family members even for basic self-care activities like bathing and dressing up. He could not even bend forward to pick anything from floor and even walking within the room was a tedious task. He started looking for a post Covid rehab facility and got re-admitted for Comprehensive Pulmonary Rehabilitation programme at Sakra World Hospital.

He had issues in carrying out conversations due to breathlessness, making him dependent on supplemental oxygen. When he enrolled for the pulmonary rehabilitation, he expressed his concerns about not being able to spend quality time with his grandchildren & other family members. While undergoing comprehensive pulmonary rehabilitation, he was gradually weaned off from oxygen, his respiratory system improved and he showed significant improvement in his exercise tolerance.

His 6 minute walk test distance (6MWT – standardized measure for functional capacity) improved from 170 metres at 4L/minute supplemental oxygen to 230 metres without any oxygen support. He regained the ability to independently do all activities of daily living and did not require oxygen support at all.  He thoroughly enjoyed the yoga therapy sessions and was highly motivated to further continue rehab sessions on outpatient basis. He has shown great improvement in his overall quality of life and self-esteem and is committed to return to life to enjoy all that life offers.

Case 2: Mr. Sanjay (Name changed), a 68 year old gentleman from Mumbai learned about our programme and has enrolled for home based rehabilitation through video consultations. He was admitted in the ICU and was there for almost 18 days. He developed Pulmonary Fibrosis as a sequel to Covid infection and was on continuous oxygen support at 5-8L/minute. Any change in position even on the bed resulted in a drop in oxygen levels.

He had feeling of chest tightness and was unable to sleep normally and had to be on a reclined position throughout in order to breathe comfortably. He was unable to walk even to the washroom and was using a commode chair next to his bed. He was emotionally low and was scared of total dependency as the days passed.

Case 3: Mr. Karthik (Name changed) a 47 year old gentleman had generalized weakness, loss of muscle mass and was not able to resume his office work due to Oxygen dependency. He enrolled for a home based rehabilitation through video consultations along with once a week centre based (OPD) rehabilitation.

He was dependent on his family to climb stairs at his home to reach his bedroom as the Oxygen levels would drop, making him breathless. Training through the systematic protocols, he learned energy conservation techniques and gained better breathing control to cope up with his challenges. He is now independently climbing stairs and is determined to reclaim life.

Dr. Sachin Kumar, Senior Consultant
Pulmonology & Critical Care Medicine,
Sakra World Hospital, Bengaluru

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Pneumonia is a general term that refers to an infection of the lungs, which can be caused by a variety of microorganisms, like viruses, bacteria, fungi, and parasites. Pneumonia is a common illness, occurs in all age groups, and is a leading cause of death among the elderly and people who are suffering from long time illness.

It is a very old disease well known to our ancestors. Hippocrates, the ancient Greek physician known as the father of Medicine had described the signs and symptoms of pneumonia accurately as early as 4^th century B.C.

Types of Pneumonia:

It can be classified in several different ways. They are

1. Acute pneumonia: It is a type which usually develops rapidly and lasts for 2 to 3 weeks. It is spread easily  and can cause symptoms very soon.  

2. Chronic pneumonia:  These develop gradually over a period of weeks to months. This type pneumonia does not spread easily.

3. Community acquired pneumonia is a common seen in people with an underlying pathology. Streptococcus is the most common bacterial cause of community-acquired pneumonia. This occurs most commonly in very young and very old people.

4. Hospital-acquired pneumonia is an infection that patients get while they’re in the hospital. This means the infection is not present at the time a patient is admitted to the hospital.

5. Aspiration pneumonia is an inflammation of the lungs and bronchial tubes caused by inhaling foreign material, usually food, drink, vomit, or secretions from the mouth into the lungs.

6. Severe Acute Respiratory Syndrome (SARS): SARS is a highly contagious and deadly type of pneumonia which first occurred in 2002 after initial outbreaks in China. SARS is caused by a virus called as coronavirus.

7. Chemical pneumonia: Chemical pneumonia is caused by chemical toxins such as pesticides, which may enter the body by inhalation or by skin contact.

Causative organisms:

It is caused by different types of microorganisms, including bacteria, viruses, fungi, and parasites.

1. Viruses: Some viruses that cause pneumonia are adenoviruses, rhinovirus, influenza virus (flu), respiratory syncytial virus (RSV), and parainfluenza virus.

2. Bacteria : The bacterium Streptococcus pneumoniae, a common cause of pneumonia. Bacteria typically enter the lung when airborne droplets are inhaled, but they can also reach the lung through the bloodstream when there is an infection in another part of the body. Many bacteria live in parts of the upper respiratory tract, such as the nose, mouth and sinuses, and can easily be inhaled into the alveoli.

3. Fungi: Fungal pneumonia is uncommon, but it may occur in individuals with reduced immune system due to AIDS or other medical problems.

4. Parasites: A variety of parasites can affect the lungs. These parasites typically enter the body through the skin or by being swallowed. Once inside the body, they travel to the lungs, usually through the blood and cause disease.

Spread of the disease:

It is a common illness in all parts of the world. It is a major cause of death among all age groups. In children, the majority of deaths occur in the newborn period, with over two million deaths a year worldwide.

Signs and Symptoms:

Symptoms vary, depending on the age of the child and the cause of the pneumonia. Some common symptoms include:

Fever, chill, cough, unusually rapid breathing, breathing with wheezing sounds, vomiting, chest pain, abdominal pain, decreased activity, loss of appetite and in extreme cases, bluish or gray color of the lips and fingernails.

Diagnosis:

1. Clinical examination:

Individuals with symptoms of it need medical evaluation. By listening into the breath sounds through a stethoscope, the doctor can detect decreased air entry into the affected part of the lung. And also the doctor can detect fever low body temperature, an increased respiratory rate, low blood pressure, a fast heart rate.

2. Other tests

Chest X-ray: An important test for detecting pneumonia. Chest x-rays can reveal areas of opacity (seen as white) which represent consolidation. Chest x-rays are also used to evaluate for complications.

X-ray picture showing

a) Normal Lungs                              b) Right lung infected with pneumonia.

Note that in this picture the Right Lung has become whitish

Blood test: Blood test is done to identify the presence of bacteria or virus which causes pneumonia. They alter the number and ratio of various types of white blood cells present in the blood.

Sputum test: Sputum of the infected person is taken and stained with dyes and examined under microscope. The organisms causing the disease can often be seen and identified.

Treatment:

Most cases of pneumonia can be treated without hospitalization. Oral antibiotics, rest, fluids, and home care are sufficient for complete healing.

Some of the antibiotics which are given to treat bacterial pneumonia are penicillin, erythromycin, azithromycin, clarithromycin, and the fluoroquinolones.

Viral pneumonia caused by influenza A may be treated with rimantadine or amantadine.

Complications:

Sometimes pneumonia can lead to additional medical problems called complications. Complications are more frequently associated with bacterial pneumonia than with viral pneumonia. The most important complications are:

Respiratory and circulatory failure:

People with pneumonia have difficulty breathing, and it may not be possible for them to breathe well enough to stay alive without support. It can also cause respiratory failure by triggering acute respiratory distress syndrome (ARDS), which results from a combination of infection and inflammatory response.

1. Pleural effusion :Pleural effusion can seen in the X-ray of the infected person. It is the condition which shows the collection of fluid around the lung. Sepsis and septic shock are potential complications of it. Sepsis occurs when microorganisms enter the bloodstream and the immune system responds by secreting cytokines.

2. Lung abscess: If it is not properly treated, it can result in pus inside the lungs called as Abscess.

Prevention of pneumonia:

There are several ways to prevent infectious pneumonia. Vaccination is important for preventing in both children and adults. Vaccinations against Haemophilus influenzae and Streptococcus pneumoniae in the first year of life have greatly reduced their role in pneumonia in children. Other methods to prevent are,

1. Avoid the use of kerchiefs, towels, cloths of an infected person.

2. Avoid the use of plates, cups, spoons which are used by infected person.

3. Use kerchiefs while coughing and sneezing.

4. Wash the hands properly with soaps.

5. Cleanliness and hygiene is most important.

6. Use masks whenever there is a high risk of acquiring the disease.

Dr. C. SHARATH KUMAR
Director and Chief Fertility Surgeon
Mediwave I.V.F & Fertility Research Hospital
City X-ray Complex, Sayyaji Rao Road
Mysuru-570 001
Phone: 0821-2444441 / 4255019

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