Respiratory system Problems in GP

Respiratory Problems in GP Opaque Patch of

Pneumonia Presented By

• Prof.Dr.

• R.R.Deshpande

• 9226910630

8/8/2015 Prof.Dr.R.R.Deshpande 1


Respiratory Problems in GP

• Presented By –

• Prof.Dr.R.R.Deshpande (M.D in Ayurvdic

Medicine & M.D. in Ayurvedic Physiology)

• www.ayurvedicfriend.com

• Mobile – 922 68 10 630

• [email protected]

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Respiratory system


Respiratory Problems in GP

• 1) Acute Rhinitis

• 2) Hoarseness of voice

• 3) Acute bronchitis

• 4) Chr bronchitis

• 5) Pneumonia

• 6) TB

• 7) Br. Asthama

• 8) Bronchieactesis

• 9) Emphysema


Causes of Cough

• 1) Respiratory causes

• 2) Cardiac

• 3) Mediastinal

• 4) Drugs

• 5) Miscellaneous

Alveoli & capillaries


Investigation for Cough

• 1) Haemogram ESR

• 2) Stool Routine

• 3) Chest X – ray (PA view) (priorly for pleurisy, pneumonia or T.B.)

• 4) AFB – Acid Fast bacilli – Mycobacterium Tubercle

• 5) Consecutive 3 days sputum examination is done

• 6) Bronchoscopy

Alveoli & Capillary


Medicines of Cough

• 1) Allergy – Anti Allergy

• 2) Antibiotic

• 3) Anti tussive – dry cough

• 4) Expectorant – for productive cough

• 5) Mucolytic – for breaking mucoid ,sticky fibers

• 6) Bronchodiator

• 7) Steroids

• 8) Anti-pyretic & Anti inflammatory NSAIDS

• 9) Avoids Irritants

• 10) Steam Inhalation.


Note Carefully

• In Respiratory & GIT problems use of

Ayurvedic Medicines show 80 % more

better results than Allopathy

• Above age – 50 years sudden change in

voice and no response to treatment then

refer to ENT surgeon for laryngoscopy

(laryngeal cancer)


1) Allergic Rhinitis

• Short attacks of severe sneezing and

running of nose.

• Allergen – Pollen dust

• Vasomotar rhinitis – Sneezing less but

blocking and running of nose. Cold

remains throughout the year

Para nasal sinuses

Allergic sinusitis

Sinusitis


Treatment of Allergic Rhinitis

• Tab – Zyrtec – 10 mg OD (Cetrizine)

• or Tab – Lorfast – 10 mg OD (Loratidine)

• These are non-sedeting drugs.

• or Rhinocort Nasal Spray

• or Otrivin Nasal drops (spray)

• Nasivion Nasal drops / nasivion pediatric nasal drop

• or Tab – Wysolone – 5 mg TDS x 5 days (Prednisolone)

• Adv. – Skull Xray to rull out – DNS – Deviated Nasal Septum & Sinusitis


2) Hoarsness of Voice

• Causes :

• 1) Infective Laryngitis

• 2) Traumatic (misuse or overuse of voice)

• 3) Malignancy

Hoarseness of voice


2) Hoarsness of Voice --

Treatment

• Advice :

• 1) No talking (whispering is more dangerous)

• 2) Steam inhalation (loose sticky secretion) Tr. Benzoic or vicks

• Tab – Roxid – 150 mg – BD x 7 days (Roxythromycein)

• Tab – Betnelan – TDS x 7 days (Betamethasone)

• Tab – Gatri – 400 mg OD (Gattifloxacin)

• Stops smoking


Hoarsness of Voice

• Caution :

• If the patient is > 50 years old No URTI, no

overuse of voice, Hoarseness > 2 weeks

refer to ENT, before treatment for

laryngoscopy.


3) Acute Bronchitis

• Clinical Features

• 1) Complaining of fever :

• 2) Cough with expectorant

• 3) Retrosternal chest pain

• O/E (on examination) Few Rhonchi and bilateral crepitations

• Adv – Bed rest and stop smoking

• Steam inhalation.


3) Acute Bronchitis-- Treatment

• Treatment :

• 1) Cap – Novamox (Amoxycillin) 500 mg QID

• 2) Benadryl expectorant 1 TSF TDS (Anti allergic)

• 3) Tab- Bromhexine 8 mg TDS (Mucolytic)

• 4) Tab- Combiflam – 1 TDS (paracetamol)

• If Dyspnoea -- Tab – Deriphylline 1 TDS (Bronchodialator)

Bronchi & Bronchioles


4) Chronic Bronchitis

• Complaining of – cough with expectoration

– at least 2 years

• O/E – Wide spread Rhonchi, basal

crepitations, prolonged expiration.

• Fever (only in exacerbation – attack)

• Adv – X-Ray

• If prominent broncho vascular makings,

which indicates chr. bronchitis


Chronic Bronchitis -- Treatment

• Adv – in acute exacerbation

• 1) Steam inhalation

• Tab – Bromhexine 8 mg TDS

• If Dyspnoea / Breathlessness then

• Tab – Asthalin (Salbutamol) 4 mg BDS

• Tab – Bricanyl 2.5 mg TDS (Terbutalyn)


Antibiotics useful in all diseases in

R.S.

• 1) Cap. Mox 500 mg TDS

• 2) Cap cephalexin 500 mg QID

• 3) Tab- Cefuroxime – 250 mg BD (Ceftum)

• 4) Tab – Levofloxacin – 500 mg OD (L – cin)

• 5) Tab – Azee – 500 mg OD (Azithromycin)

• 6) Tab – Bactim DS – 1 BD (very cheap

antibiotic)

• 7) Tab wysolone (prednisolone) 10 mg TDS if

bronchospasm persists.


Chronic Bronchitis -- Treatment

• After acute attack -- medicines to prevent

recurrence.

• 1) Tab Doxy – 1 --100 mg, 1OD (doxycycline)

• 1st – 5th day of each month

• 2) Cap. Novamox – 500 mg -- When the cough

becomes purulent, yellow / greenish immediate

start this tab 1 TDS.

• Adv – 1) Stop smoking completely

• 2) Avoid Irritants


5) Pneumonia

• C/O – High grade fever with chills.

• Cough with expectoration, unilateral chest

pain,

• Patient looks very toxic and ill

• O/E bronchial breathing, localized

crepitations, less air entry

• X-Ray -- White opaque patch.

Alveoli in Pneumonia

Pneumonia Lung Patch

Symptoms of Pneumonia

X ray of Pneumonic patch

DD of Broncho & Lobar Pneumonia

Broncho pneumonia Lobar pneumonia

1) Organisms Strepto haemolyticus Diplococcus pneumonia.

2) Age Extreme of age i.e. in

children and old people.

Young adult

3) Pathological lesion Both lungs diffused. Limited to right lower

lobe

4) Onset Insidious Acute

5) Toxemia More Less

6) Temp. Not so high but

remissions

High temp. & continued.


DD of Broncho & Lobar Pneumonia

Broncho pneumonia Lobar pneumonia

7) Signs Patchy and bilateral Unilateral, located to the

right lower lobe.

8) Course (Duration) More (15 – 1 month) 7 – 10 days.

9) X-Rays Diffused finding Opaque shadow at rt.

lower lobe.

10) Air entry Not specific Is less

11) Complications Common Rare

12) Treatment Antibiotics in hospital

i.e. through I/V

In G.P. – Antibiotics

gives


Pneumonia 3


Pneumonia - Treatment

• Same antibiotics like the previous

diseases, but Tab Roxid – covers nearly

all the organism, responsible for

pneumonia


Pneumonia

• Caution – Pneumonia patient should be admitted in following conditions

• 1) Age > 60 years

• 2) Co-existing illness – DM

• 3) High fever, dehydrated, toxic (Thready and feeble pulse)

• I/V and antibiotics

• 4) X-Ray – Shows involvement of more than 1 lobe (broncho-pneumonia)

• 5) If patient refuses or unable to take medicine orally.

• In addition to antibiotics also gives Tab-combiflam and Benadryl expectorant.


Breathless / Dyspnoea

• 1) Respiratory causes : 80 %

• 2) Cardiac causes

• 3) Other

• 4) Psychological


1) Respiratory causes of

Dyspnoea

• a) Acute Asthma

• b) Acute exacerbation of COPD

(chr. bronchiatis)

• 3) Pneumonia

• 4) Massive pleural effusion

• Admit – If

• 1) Pneumothorax

• 2) Pulmonary embolism

• 3) Pulmonary oedema / cardiac asthma / CCF


2) Cardiac causes of Dyspnoea

• 2) Cardiac Causes :

• a) Acute LVF

• b) Valvular heart disease


3) Other causes of Dyspnoea

• a) Renal failure (Uremia – breathlessness

increases) Adv – Urea , Creatinine

• b) Diabetic ketoacidosis / Daibetic coma


6) Pulmonary TB

• Cardinal symptoms of T.B.

• 1) Persistent cough with expectoration of long duration ( more than 3 weeks)

• 2) Recurrent respiratory infections are common.

• 3) Dyspnoea is generally not prominent at rest but is more on exertion.

• 4) Cyanosis : Patients are called "blue bloaters

• 5) Features of right heart failure (Cor pulmonale) are common.

• 6) Chest X-ray shows enlarged heart with prominent vessels.

Symptoms of Tuberculosis

TB

Honeycomb Lung


Treatment of T.B.

• A) Sputum positive – New Patient

• HRZE for 2 months

• HR x 4 months

• AKT 4 1 kit per day x 2 months & cap

Rcinex 100 x 4 months (Rifampicin)

• clinical, radiological and pathological

(sputum)

Mycobactrium Tubercle Bacilli


Treatment of T.B.

• B) Sputum negative – New pt.

• on clinical and radiological

• HRZ – 2 months

• HR – 4 months

• Rimactazid – Z 1 kit/day x 2 months

• Cap Rcinex 100 x 4 months.


Treatment of T.B.

Sr.

No

Drug Child

Dose(mg/kg

/day)

Adult

Dose

Side Effect

1 Isonex

(H)

10 to 20 300 MG Neuritis,Rash

2 Rifampicin

(R)

10 to 15 450 MG Hepatitis,

Rash, Red Urine

3 Pyrazinamide (Z) 20 to 30 1.5 gm Hepatitis,

Arthralgia


Treatment of T.B.

Sr.

No

Drug Child

Dose

(mg/kg/d

a)

Adult

Dose

Side Effect

4 Ethambutol

(E)

15 – 25 800

gm

Optic neuritis

– check

vision

5 Streptomycin

(S)

20 – 40 1 gm Autotoxicity

(irreversible)

Progress of TB


Treatment of T.B.

• Adv :

• Avoid crowded places & House rest for

minimum 1 month.

• Restrict complete physical & mental

stress.

• Takes high protein diet, milk – 1 lit / day,

egg, meat and Tonic like Chavanprash

• Give supportive Ayurvedic treatment

DD of Bronchial & Cardiac Asthama

Bronchial Asthma Cardiac Asthma

1) Pathology Bronchospasm Pulmonary congestion

oedema.

2) Age Young Elderly (above 50-60

years)

3) Sex Both Male mostly

4) Past history Of Eczema, urticaria (allergy)

suseptibility to cold, allergy to

polon, groundnuts, eggs.

No history of allergy, very

few attacks, LVF, RVF

5) family history Other family members may

have similar disease.

Hypertension may run in

families

6) personal history Highly sensitive individual Nil




7) Onset Acute, usually in early hours

of morning or late hours of

night.

Acute usually at

midnight (very specific)

8) Symptoms a) Expiratory Dyspnoea

b) Expectoration – scanty &

mucoid

c) No palpation cough with

sticky mucus.

a) Both dyspnoea expi.

& inspiratory

b) Profuse and frothy

c) Palpatation present

d) lot of sputum




9) O/E in

examination

a) Expiratory wheez present

b) sweating absent. may be present

c) cyanosis absent

d) pulse rate may be high

e) BP normal or slightly more

systolic

f) Heart sounds are distant (normal)

a) Absent (basal crepts and

rate)

b) sweating present

c) Cyanosis present

d) Very high (may be pulsus

alterance)

e) BP usually high.

f) 3 heart sounds Gallop

rhythm may be present in

mitral area

10) Examination of

lungs

Plenty of wheezing bronchii. Plenty of Rales & basal

crepitus




11) Treatment Antiasthematic,

antiallergic,

bronchodialators –

Asthalin, inj – Adrenalin

S/C. I/V deriphylin, inj –

Amonophylin.

Inj – Lasix (diuretic)

I/V admit patient, inj

– Aminophylin

Diluted in glucose &

given very slowly

(for 10-15 min)

Adrenalin not gives

in


Bronchial Asthama


Bronchial Asthma

• 1) Asthlin inhaler (salbutamol) 2 puff

• 2) Inj – Deriphyllin – 2CC

• 3) or Inj. Alupent 2CC – IM/SC

(orciprenalin)

• 4) Inj – Salbutamol – 0.25 mg I/V slowly

Asthama inhaler


Bronchial Asthma

• If patient is young

• 1) Isoprenalin autohalor – 2 puff

• 2) Inj – Adrenalin – 0.5 ml s/c


Bronchial Asthma

• If attack is severe

• Inj – Aminophyllin – 10ml -diluted in 25 %

dextrose 10 ml, I/V very slowly in 5 mins

• or Nebuliser – Asthalin or Ipratropium


Bronchial Asthma

• C) If still not relieved with Aminophyllin

• 1) Repeat inj. Aminophyllin

• 2) Inj. Efcorlin – 100 mg I/V

(Hydrocortisone – steroid) or inj. Decadron

(Dexamethasone)

• & O2 by nasal catheter.


The patient should be admitted if

• 1) Patient is too breathless, to talk

• 2) Pulse > 120/min

• 3) RR > 30/min in children / young and in adult > 50/min.

• 4) Cyanosis present – central – tongue, lips etc, peripheral – tips of fingures

• 5) Bradycardia, hypotension, exhaustion

• 6) Silent chest – due to complete broncho spasm (no respiratory sounds)


Maintenance of

Bronchial Asthma

• A) Mild intermittent Asthma :

• Attack < one / week & mild

• Treatment

• 1) Asthalin – Inhalar – 2 puff stat. & then BD

• 2) Tab – Asthalin 4 mg BD or

• Tab – Deriphyllin (Theophyllin) 1 TDS

• Tab – Bricanyl 5 mg BD (Terbutalin)


Maintenance of

Bronchial Asthma

• B) Mild Persistent Asthma :

• Attack > 2 times / week, but not daily.

• Treatment

• 1) Asthalin – inhaler 2-3 puff. if attack

occur

• 2) Beclate inhaler 500 mg BD to prevent

that attacks (Beclomethasone)


Maintenance of

Bronchial Asthma

• C) Severe Persistent Asthma

• Attack daily

• Treatment

• 1) Beclate – inhaler – 500 mg BD

• 2) Serobid inhaler – 1 puff BD

• 3) Asthalin – 2-3 puffs (SOS)

• Tab – Wysolone (Prednisolon) 5 mg TDS (SOS)


Kindly Note

• It is proved that for the Asthmatic patient

duration is not important severity of attack

is important

• So there is change in the concept of

Status Asthamaticus

Bronchiole & Alveoli


Bronchiectasis

• Permanent dialation of bronchioles

• Causes – Chr. respiratory diseases like chr. Brochitis

• Symptoms

• Cough with expectoration –Related to change of posture, hence prominent in early hours of morning or while going to bed.

• Copious and purulent

• Rarely haemoptysis

• Chest pain recurrently, due to dry pleurisy.

• febrile episode (attack) due to sec. infection.

Bronchiectasis

Vocal cords – Vicious cycle

X ray of Bronchietasis


Bronchiectasis

• General symptoms:

• Malaise, loss of weight

• O/E -- Clubbing

• Impaired Resonance – Percussion -- dull note

• Vocal resonance decreases

• Basal – plenty of leathery rales

• X-Ray Chest (PA view) --- Thickening of basal pleura.

• Bird’s nest – appearance of basal lung.


Bronchiectasis

• Treatment

• 1) Postural Drainage : in the morning

• 2) Bronchoscopic Aspiration

• 3) Antibiotics (Bed ridden pts. are kept

under antibiotic cover and surgical

invention is done when necessary )


Tropical Eosinophilia

• C/O Intractable cough – not responding to

routine treatment

• Adv – PBS – for absolute Eosinophil count

• IF Eosinophil is greater than 30 to 40 %


Tropical Eosinophilia

• Treatment :

• Tab- Hetrazan – 100 mg TDS x 1 month

• Diethyl carbamazin citrate

• Tab wysolone ---Tapering Dose

• 1 – 1 – 1 2 days

• 1 – 0 – 1 2 days

• 1 – 0 – 0 2 days and then stop

• Note that Antiepileptic, Antihypertensive and steroids should not be suddenly stop.

COPD


Emphysema

• Definition :

• Over distension of alveoli with rupture at

some places – due to chr. bronchitis or

chronic bronchial asthma.

• Dyspnoea – exertional to begin with and

then at rest also. Aggravation from time to

time, due to repeated infections


Emphysema

• In advanced cases dyspnoea increases,

even after normal routine movements e.g.

after eating, talking, defecation.

• Cough with expectoration – due to

associated chr. bronchitis.

• Wheezing sound

• Gradual weakness and loss of weight


Emphysema

• Sign

• 1) RR increases

• 2) Central cyanosis (tongue bluish)

• 3) Decubitus (special gait) -- propped up and

stopping forward.

• 4) Inspection : Barrel shaped chest

• 5) At the line of diaphragmatic attachment,

varicose veins are prominent called as

• Emphysematous Girdle


Emphysema

• Papation – VF (Vocal fremitus) decreases

• Percussion – Hyper resonant note.

• Auscultation – Breath sounds are

diminished,

• vesicular with prolonged expiration, VR

decreases (vocal resonance)


Emphysema

• X-ray – Radio translucent – lung fields, low

and flat diaphragm, elongation of cardiac

shadow – ‘Tubular heart’

• Complications

• Right sided heart failure – chronic cor-

pulmonale“( In ECG – Tall P wave – P

pulmonale)


Emphysema

• Treatment

• 1) Breathing exercises.

• 2) Antibiotics to prevent sec. infection,

intermittent O2 for CCP : diuretics (Lasix)

salt less diet and digitalis in CCF (gives

strength to heart)


Good Experiences

• Anti Allergic –

• Tab Relent =cetrizine Hcl 5 mg+ Ambroxol

hcl 60 mg -- 1 Tab at night

Cough ( Kasa)

• Gojihvadi Kwatha 20 to 40 ml TDS

• Sitopaladi Churna 5 to 10 gm TDS

• Kantakaryavaleha 5 to 10 ml TDS


Expectorant ( Kapha Nissarana)

• Tankan Bhasma 500 mg to 1 gm TDS

• Talisadi Churna --- 3 to 5 gm TDS

• Vasavleha – 5 to 10 gm TDS


Bronchitis ( Svasanika shoth)

• Laghu malini vasant -- 2TDS

• Lavangadi Churna – Half tsf tds with

honey

• Chousashtha Pippali churna -- Half tsf tds

with honey


TB ( Rajayakshma)

• Raj mrigank ras – 250 mg TDS

• Suvarna malini vasant – 1 tab tds

• Shataputi Abhrak bhasma – 125 mg tds

• Mukta panchamruta – 250 mg tds

• Shilajitvadi Lauha – 500 mg tds


Common cold ( Pratisyaya)

• Hinguleshvara rasa 250 mg tds

• Panchakola churna half tsf tds with honey

• Nag guti ( very Hot) – Not for Pitta Prakruti

• Cap Nesolarin ( Phyto Pharma) – Nag guti

+ Sameerpannag – 1 cap BD


Sinusitis ( Peenas)

• Shadbindu oil 3 drops TDS

• Dashamula Rasayanam – 2 tsf tds


Powders to treat Respiratory

problems like Asthama,Cough

• 1) Sitopaladi (Piitaja Kasa)

• 2) Karpuradi ( Kaphaja Kasa)

• 3) Talisadi ( Vataj Kasa)

• 4) Chausastha Pimpali

• 5) Shrungyadi

• 6) Yashtimadhu

• 7) Katphaladi

• 8) Bhagottar


Ayurvedic Tablets for Respiratory Problems

• Cough --- Anandabhirav Kasa

• Cold,Cough,Br.Asthama – Lavangadi

vati,Naga guti,Chaturbhuja rasa,Shwas

kuthar

• Tuberculosis ( Rajayakshma) –

Shriphalakusum vati ,Vasanta Kalpa like

Suvarna malini vasant


Ayurvedic Medicines for Respiratory Problems

• Tubercular Lymphadenitis – Kanchanar Guggulu

• Tonic in diseases like Tuberculosis, Chronic cough,

Br.Asthama – Drakshasav

• Cough,Br.Asthama – Kanakasav,Vasakasav,Vasadi

kadha

• Allergy ,Chronic sinusitis – Bhallatakadi

Kadha,Bhallatakasav

• Respiratory problems ( Rasayan for RS) –

Chavanprash, Dhatri Rasayan, Amalaki Avaleha


Ayurvedic Jams for Respiratory Problems

• Cough or Haemoptysis – Vasa Avaleha,

Vasa Ghruta

• Chronic cough,Ch.Bronchitis –

Katakaryavleha

• Cough,Br.Asthama – Ardrakavleha


Ayurvedic Medicines for Cough

• Katphaladi or Karpuradi or Talisadi or Sitopaladi or

Dadimadi or Yashtimadhu or Shrungyadi Churna

• Lavangadi or Eladi or Sitopaladi Vati

• Drakshasav, Punarnavasav

• Agastya Hartaki avaleh,Ardrakav leh (Aalepak)

,Kantakaryav leh, Chavanprash,Vasav leh,

• Vasa Ghruta, Lakshadi Tail,

• Kasis bhasma, Lokanath ras, Shrunga bhasma


Ayurvedic Medicines for

Bronchial Asthama • Karpuradi or Dadimashtak, Pippalyadi or

Yashtimadhu, Samsharkar chuna, Chausashta

Pippali

• Bruhatvat chintamani, Suvarna malini vasant

• Kanakasav,Draksav,Dashamularishta

• Swaskuthar


Ayurvedic Medicines for

Bronchial Asthama • Ardrakav leh, Chavanprash,

• Dadimvleh, Dhatri rasayan, Lashun pak,

Vasavleh,

• Narayan tail

• Abhrak bhasma, Manikya ras, Shrunga

bhasma, Makardhwaja, Mallasindur,

Rasaparpati,Rasa sindur, Loknath ras,

Sameerpannag



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Respiratory system Problems in GP

Education

hoarseness of voice

respiratory problems

overuse of voice

hoarsness of voice causes

causes of cough

respiratory causes

medicines of cough

hoarsness of voice caution