Early identification and treatment are critical in the management of pulmonary fibrosis. Although there is no cure, drugs such as antifibrotics can help delay the disease’s course. Oxygen treatment is frequently required to maintain optimal oxygen levels in the body, particularly during physical activity or sleep. Lung transplants may be a realistic choice for certain people when other therapies fail.

Living with pulmonary fibrosis necessitates significant lifestyle modifications. Patients are advised to participate in pulmonary rehabilitation, which involves breathing exercises, physical activity, and information on symptom management. These programs assist to improve lung function, alleviate symptoms, and boost general well-being. Quitting smoking, avoiding pollutants, and getting immunisations against respiratory illnesses (such as flu and pneumonia) are all important steps in protecting lung health.

Emotional toll is another aspect of having pulmonary fibrosis. The unpredictable progressive course of the illness frequently causes patients to feel stressed, depressed, and anxious. Individuals can share their experiences and better manage the psychological effects of the illness with the emotional support that support groups and counselling provide.

Those suffering from pulmonary fibrosis can better manage their symptoms and navigate life with the condition if they receive medical care, make lifestyle adjustments, and develop mental resilience. Ongoing research and campaigning raise hopes for better treatments and, one day, a cure.

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The theme for World No Tobacco Day 2024 is “Protecting Children from Tobacco Industry Interference.” This year’s focus is on protecting young people from the tobacco industry’s deceptive techniques, which increasingly target children through various marketing strategies, particularly on social media and streaming platforms. The campaign intends to highlight the tobacco industry’s misleading techniques that entice young people to smoke and vape, posing major risks to their health and well-being (UICC) (World Health Organisation (WHO)).

Tobacco use is the largest cause of preventable death worldwide, accounting for more than 8 million deaths per year. It is associated with a number of significant health issues, including lung cancer, heart disease, stroke, and chronic respiratory disorders. Second hand smoking also has serious health consequences, particularly for youngsters and non-smokers.

By raising awareness, promoting strict regulations and providing support for cessation initiatives, we can fight this battle. Together, we can protect future generations and build a healthier, tobacco-free society.

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Bronchiectasis is a chronic condition of the lungs that has affected hundreds of thousands of people worldwide.  The second world bronchiectasis day will be celebrated on 1^st July, 2023. The purpose of this is it to spread awareness about the disease, and to provide a platform for the patient as well as the care givers of these patients to best manage the disease.

BRONCHIECTASIS

Bronchiectasis, is a lung disease, in which the airways become enlarged or scarred. The damaged airways are unable to clear up the mucous properly, which results in recurrent lung infections. It’s a chronic condition affecting single or both lungs.

In most of the cases the cause remain undiagnosed, this is called as Idiopathic Bronchiectasis.

Other causes includes, condition causing infections or inflammation which damages the airways leading to bronchiectasis. There are certain genetic condition, in which the cilia (small thread like structure in the airways, which clear the secretions with their movement) malfunctions, leading to recurrent infection and developing bronchiectasis. Another condition is cystic fibrosis, in which there is production of thick sticky mucus which is hard to clear and causes recurrent infections and further damage to the airways.

Currently, no cure has been found for this disease. Treatment of bronchiectasis is aimed towards, early diagnosis, to treat the cause, prevention of further damage, and preventing future exacerbations.

Preventive measures involve good pulmonary toilet, which includes clearing of mucous with physiotherapy, airway clearance manually or assist devices and medicines. These can improve quality of life and may impact the longevity of those affected.

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As the airways are damaged, drainage of the secretions gets impaired and secretions build up in these damaged breathing channels. The impaction of the thick secretions leads to recurrent infections and inflammation, which further causes damage to those airways “a vicious cycle”.

Symptoms:

• Persistent Cough with discoloured phlegm
• Occasional haemoptysis ( coughing up blood)
• Shortness of breath
• Fatigue
• Fever
• Weight loss
• Chest pain

Causes of Bronchiectasis

It is often brought on by damaged from other condition, infection (pneumonia, tuberculosis), cancer, non-infectious pneumonia, autoimmune disease and diseases that causes structural abnormalities. And on occasion the cause remains unknown it’s called Idiopathic Bronchiectasis

Diagnosis

If you are suffering from persistent cough lasting more than a month, associated with copious phlegm, visit a Pulmonologist/ Chest Physician to get an accurate diagnosis.

The diagnostic evaluation includes a detailed medical history, a thorough physical examination followed by certain investigations like blood and sputum tests and radiological assessment. An HRCT chest assists in confirming the diagnosis of Bronchiectasis. Lung assessment tests including spirometry and lung volume assessment are also done to estimate the functional capacity of the lungs. In certain situations, a bronchoscopy is performed to visualise airways and to remove the secretions and foreign body from the lung.

Treatment

Managing bronchiectasis requires diagnosing and treating the cause to prevent the progression.  Clearing up the thick secretions and managing the infections is the cornerstone of therapy. The use of nebulized hypertonic saline, chest physiotherapy and acapella devices assists in regular removal of the thick secretions. Additionally, the judicious use of appropriate antibiotics (inhaled and systemic) is essential to treat the exacerbations.

Regular follow ups with your Pulmonologist/Chest Physician plays a key role in prevention of the flare up.

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The World Health Organisation’s World No Tobacco Day is every year on 31st May. It was created to bring awareness to more people about the dangers and health risks of smoking tobacco, and ultimately, to stop use of tobacco around the world

Over 1 billion people worldwide are tobacco smokers, majority of whom ( up to 80%) are in low-income countries where tobacco-related disease and death will have the hardest impact. Over 7 million people die because of smoking tobacco alone.

Tobacco use is one of the most lethal global health hazards. Smoking tobacco and passive or second-hand smoke, causes cancer of mouth, lungs liver, urinary and gastrointestinal tracts amongst others. It is the 2^nd most important risk factors for heart disease, directly damages lung causing diseases like COPD, interstitial lung diseases (ILD) and Emphysema, contributes to chronic illnesses like Diabetes, vascular diseases, eye problems, weakening of bones and muscle.

The theme for this year “ world no tobacco day”  is “we need food, not tobacco!” this was the 34th annual No Tobacco Day the WHO.

This year the global campaign aims to raise awareness about alternative crop production and marketing opportunities for tobacco farmers and encourage them to grow other sustainable and nutritious crops.

World No Tobacco Day (WNTD) was initiated by the member states of the World Health Organization in 1988. The WHO had started a campaign to enlighten the public about the health-related problems caused with tobacco consumption and its impact on the community.

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Over view

• Mpox is a viral illness caused by a virus named Monkey pox.
• Mpox can spread from person to person or occasionally from animals to people.
  • transmission of mpox can occur through direct contact with infectious skin or other lesions such as in the mouth or on genitals; this includes contact which is
  • face-to-face (talking or breathing), respiratory droplets or short-range aerosols from prolonged close contact.
  • skin-to-skin, mouth-to-mouth and mouth-to-skin contact.
  • Animal to human transmission of mpox occurs from infected animals to humans from bites or scratches, or during activities such as hunting, skinning, trapping, cooking, playing with carcasses, or eating animals.

• A global outbreak occurred in 2022–2023
• It can cause a painful rash, sore throat, headache, enlarged lymph nodes and fever. Rash maybe he first symptom, it is fluid filled an itchy. Later it dries up, crusts over and the fall off. It develops itn different areas of the including face, mouth, throat, genital areas, arms and soles.
• Treatment is supportive.
• Recovery takes about 2- 4 weeks.

Things to do if you have Mpox

• stay home and keep yourself away from people at home as well, till your rash heals.
• Maintain good hand hygiene, wash hands often with soap and water or hand sanitizer, especially before or after touching sores
• Practise wearing the mask even at home, when you are interacting with your family member.
• Skin should be kept dry and not to be covered.
• Practise frequent use of disinfected after touching surfaces or object if they are being shared with any other member who isn’t infected.

Things not to do if you have Mpox

• Do not scratch the sores or pop blisters, as they can become infected and can lead to further spread of the rash.
• Do not try to remove the dry scale/ crusts. This can also to spread of the rash in different areas of the body. This also delays the healing process.
• Do not unnecessarily touch objects, hand shaking, or meet with another person.
• Do not break your isolation without a physician’s advice.
• Do not do any remedy, orally or topically without your physician consultation.

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Asthma is a chronic respiratory disease involving inflammation and narrowing of the breathing channels called airways that is one of the major non-communicable diseases worldwide. There are more than 334 million individuals that currently suffer from asthma. The prevalence of asthma continues to rise, particularly in low and middle-income countries.

In the last 10 years, the Global Initiative for Asthma (GINA), US based National Heart Lung and Blood Institute (NHLB), and the World Asthma Foundation have organized World Asthma Day.

The theme for world asthma day for 2023 is “Asthma care for all”.

The purpose of this theme is to bring awareness to the public about Asthma and promoting development and implementation of effective management programs in all resource countries.

Asthma is not a curable disease, but with appropriate management, we can reduce the frequency of acute asthma attacks, and recurrent hospital visits.

Asthma is hypersensitivity of the airways to certain allergens in the air. Hence the platform is made to provide awareness on a global scale not only to the sufferers but also the caretakers. With proper treatment an individual can lead a normal life.

Identifying the triggers and removing the misconceptions and myths about asthma is the cornerstone of therapy. Regular use of maintenance medications will keep the asthma under control in most patients.

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An allergic response occurs when the body’s immune system proteins also called antibodies mistakenly identify a harmless substance, such as tree pollen or animal dander, and considers it as an invader (allergen). This misrecognition causes an allergic reaction to result. Antibodies formed by the body bind to the allergen in an effort to shield your body from the chemical.

Your immune system’s production of chemicals causes allergy symptoms and signs like runny nose, itchy eyes, and skin rashes. Individuals may experience a similar reaction in their lungs and breathing channels or airways, which causes inflammation and tightening of the airways resulting in symptoms of asthma. These symptoms include cough, chest tightness, wheezing and shortness of breath.

What are the common Allergens causing Asthma?

The common allergens found in the environment that causes symptoms of allergies and asthma include Pollen, Animal dander, Dust mite, Smoke and pollution amongst others. Certain foods ( e.g Peanuts , shell fish etc) can trigger an allergic response in a person ranging from mild rash to a severe allergic reaction called “Anaphylaxis”

Are allergies and asthma treated differently?

Most treatments are designed to treat either asthma or allergic rhinitis. But a few treatments help with both conditions. The main treatment modalities include

Antihistamine: They are a class of drugs that are commonly used to treat the symptoms of allergies including sneezing, itchy eyes and nose, rhinorrhea (runny nose) and skin rash like urticaria. They control these symptoms by inhibiting “Histamine”, a chemical that is released by the body in response to an Allergen.

Inhaled Steroids: Steroids improve the symptoms of asthma by controlling inflammation, swelling and mucus production in the airways. Inhaled steroids are the mainstay of treatment of asthma. Regular use of steroid inhalers results in better control of asthma, reduces the risks of an asthma attack and hospital admissions. The side effects of inhale steroids are uncommon. Oral thrush            ( fungal infection) and hoarseness may be seen with regular usage and can be managed by antifungal drops or lozenges and thorough gargling after the use of inhalers

Modifier for Leukotrienes (Montelukast) The symptoms of allergic rhinitis and asthma can both be reduced by this kind of treatment. This daily medication, known as a leukotriene modulator, aids in regulating the immune system and the chemicals released through its biological pathways after an allergic reaction. The leukotriene modulators can control the symptoms of allergic rhinitis as well as asthma.

Bronchodilators: These are medications that relax the smooth muscle bands that tighten around the airways in asthma and COPD. This opens up the breathing channels making it easier to breathe and clear the mucus. They are 2 main categories of bronchodilators. Beta 2 agonists and anticholinergics. They are either long acting bronchodilators which are used as “controllers” that maintain the effect for an extended period making it easier to breathe throughout the day or short acting bronchodilators that have a rapid and more potent action . These short acting bronchodilators are used for symptom relief in an acute episode of shortness of breath.

Allergy shots (immunotherapy). By progressively lowering your immune system’s response to some allergy triggers, allergy injections can help cure asthma. Immunotherapy entails getting a small amount of the allergens injected in your body on a regular basis. This is almost like receiving a vaccination that can be protective against a disease.

Over time, your immune system develops a tolerance to the allergens, and your allergic symptoms lessen. As a result, asthmatic symptoms also get better. Typically, this course of treatment calls for repeated injections or controlled exposures over time.

Anti-immunoglobulin E (IgE) therapy. When you have an allergy, your immune system misinterprets a certain substance as harmful and secretes IgE antibodies against the offending allergen.

The IgE antibodies detect that allergen the next time you come into contact with it, alerting your immune system to release histamine and other chemicals into your bloodstream. Medicines can blocks IgE in the body to help prevent allergic reactions that cause asthma symptoms. Although it may also benefit allergic rhinitis, this medication is recommended for more severe allergic asthma.
To manage allergies or asthma, you might need additional medicines, particularly if your symptoms occasionally get severe. However, one of the most crucial actions you can take is to identify and stay away from the things that make your symptoms worse. This is one of the primary ways to protect yourself and reduce your need for medication.

Who is at risk of allergic asthma?

A significant risk factor for allergic asthma is a family history of allergies. Your risk of developing asthma is also increased if you yourself suffer from seasonal allergies or other allergies.

Is all asthma caused by allergies?

Despite the fact that allergic asthma is relatively common, there are other types of asthma with various triggers that can cause similar symptoms. Exercise, illnesses, cold air, gastro esophageal reflux disease or even stress itself can all be asthma triggers for certain people. People have multiple asthma triggers.

If you have symptoms of asthma, it is important you are appropriately evaluated by your chest specialist/ pulmonologist. This helps you to receive the most up to date treatment regimen to control your symptoms and minimize their side effects as well as potential un-expected problems for the future.

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COVID, Influenza (Flu) and RSV (respiratory syncytial virus) cause a host of respiratory illnesses ranging from mild symptoms to life threatening pneumonia.

Their overlapping symptoms, and similarity with common cold cause delay in the diagnosis and hence timely and proper management.

 RESPIRATORY SYNCYTIAL VIRUS (RSV)

It is a virus affecting air passages and lungs. It is a common viral infection that mostly affects young children. Older children and adults may also be infected with RSV.

 How does it spreads?

It is a contagious infectious disease, that is easily spread from person to person.

The virus is carried via respiratory droplet. A person can contract the respiratory syncytial virus through their mouth, nose, or eyes, when an infection person coughs or sneezes close to you. The virus can also spread by direct touch, such as hand-to-hand contact, on hard surfaces like toys, crib rails, and countertops, the virus can live for hours. After contacting a contaminated object, if you touch your lips, nose, or eyes, you are likely to pick up the virus. An individual remains infectious from the start of the symptoms to up to 10 days of illness.

 Sign and symptoms:

The virus affects our breathing passages, which start from the nose, throat, air passages (bronchioles) and down to the lungs. Symptoms are usually mild including: Coughing, Runny nose, sneezing and wheezing (abnormal breathing sounds. Some general signs like fever, loss of appetite and irritability.

In severe cases, air passages in the lung get severely inflamed leading to fast/rapid breathing, nasal flaring, purses lip, bluish discoloration of skin which is a sign of low oxygen supply to the tissues.

High risk group developing severe infection: newborns particularly premature infants, older adults, those with heart and lung disease, or those with weakened immune systems, are susceptible to severe infection from RSV.

Children older than 5 years and adults may not have any symptoms of RSV, or they’ll have very mild symptoms. If a child or adult does get symptoms of RSV, they’re similar to symptoms of the common cold and include: Runny nose, Congestion, Mild headache, Sore throat, Cough, Fatigue and Fever.

Diagnosis:

A detailed medical history and examinations helps in making the diagnosis. Nasal swab for PCR confirms the diagnosis.

TREATMENT

RSV usually goes away on its own within one to two weeks. Milder symptoms can be treated at home with antipyretics (medicine for fever like acetaminophen or ibuprofen), drinking fluids to stay hydrated and eating regularly even if you have a low appetite, applying saline nasal drops to loosen mucus in your nose and getting plenty of rest.

For severe RSV one should immediate attention from a health care provider, as it may require hospitalization.

Antibiotics aren’t a treatment option for viral infections like RSV, unless a superimposed bacterial infection is suspected. In such it will be a decision of your health care provider for choosing appropriate antibiotic.

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Omicron has mutated again giving rise to a new sub variant XBB.1.5, which has raised concerns, as its rapidly spreading in many countries across the world.

WHAT DO WE KNOW?

The family of XBB is found to be more immune-evasive than any other variants. The mutations has made the virus bind better to the cells, making it more transmissible.

Transmissibility:

• The period of infectiousness is similar to previous Covid sub variants. One remains contagious one to two days prior to development of the symptoms and alteast two to three days after the symptoms end. Isolation of 10 days is recommended

Previously infected with Omicron, can get reinfection with new variant:

• People who have been infected by Omicron can get reinfected with XBB variant. As mentioned this sub variant is more immune- evasive and with time the natural immune response decrease.

What are the symptoms of the XBB1.5?

            Symptoms of fever, sore throat, body aches, runny nose, headache, diarrhea and chest congestion are similar to previous infections

Are the current antiviral therapies effective?

Paxlovid, the oral antiviral has shown to be somewhat effective in controlling severe infections and hospitalizations. However, the older monoclonal antibodies are not effective

Covid Bivalent vaccine is effective against the new variant:

The studies done so far have shown that bivalent is still effective in protecting against severe disease. The XBB variant is derived from Omicron variant BA.2, the bivalent vaccine though developed for variant B.5, its shown it does generate antibodies that recognizes BA.2, thus providing some level of protection against XBB sub variant.

It’s highly recommended to receive the bivalent (updated) vaccines for those who haven’t yet taken their shot.

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