Pulmonology: Respiratory Conditions and Treatments

Lungs, the spongy, cone-shaped vital organs located on either side of the chest in the human body, are the lifeline that defines our total well-being. Between every inhalation and exhalation, the body performs a broad spectrum of functions, from powering each cell with oxygen to ejecting carbon dioxide and protecting the body from various pollutants.

In medical terminology, the study of lungs, functions, diagnosis, and treatment of various respiratory conditions is known as Pulmonology, Pneumology, or Respiratory medicine. Be it acute or chronic, treating lung conditions demand pulmonologists with world-class expertise and state-of-the-art diagnostic and treatment facilities to breathe easy!

The Department of Pulmonary and Critical Care Medicine at Apollo Hospitals, Bannerghatta, Bengaluru offers the best, most detailed, and most accurate diagnosis, consultations, ICU and Critical Care facilities. It also offers comprehensive pulmonary function testing and houses a sleep disorders clinic, besides round-the-clock Respiratory therapy services.

Conditions Treated:

Chronic Obstructive Pulmonary Disease:

COPD, or Chronic Obstructive Pulmonary Disease, is a common term for various lung conditions, including Chronic bronchitis and Emphysema. If not treated on time, COPD can cause significant complications, restrict the quality of life, and be fatal. The most common signs and symptoms of COPD include trouble breathing, persistent cough, blocked airflow, sputum mucus, tight chest region, and severe wheezing.

COPD needs immediate medical intervention. Preventive therapy often forms the first line of treatment in patients suffering from other respiratory ailments. The lack of timely medical support can aggravate this condition rapidly and lead to irreparable lung function damage.

 

What Is Chronic Bronchitis?

Chronic bronchitis is the inflammation of the lining of the bronchial tubes that transport air to and from the alveoli or air sacs of the lungs. The primary symptoms of bronchitis are continuous cough and excessive production of mucus.

What Is Emphysema?

Emphysema is often caused due to smoking, where the air sacs at the end of bronchioles or smallest air passages get destroyed.

What Are The Symptoms of COPD?

• Difficulty breathing, especially on exertion of pressure or strenuous activity
• Tightness in the chest
• Persistent cough with mucus that can either be clear or yellow or green
• Fatigue and frequent lung infections
• Edema or swelling in ankles and feet
• Unintended weight loss in advanced stages

What Causes COPD?

The primary causative factor for COPD is smoking. If you are a smoker, quit right now!

Other risk factors include frequent exposure to dust, animal dander, and fumes from burning oil.

Patients who have asthma or other chronic respiratory illnesses are susceptible to COPD.

In less than 1% of people, genetic factors like alpha-1-antitrypsin deficiency can trigger this respiratory condition.

How Is COPD Diagnosed?

COPD is diagnosed with the help of imaging tests, including X-rays, CT scans, blood tests, various pulmonary function tests, and arterial blood gas analysis.

Chronic Obstructive Pulmonary Disease can lead to various complications, including frequent respiratory infections, the risk of cardiovascular diseases, pulmonary hypertension, and lung cancer.

Your doctor would suggest medications, including antibiotics, bronchodilators, and oral or inhaled steroids, in conjunction with various lung therapies like oxygen therapy and lifestyle changes.

Sometimes, the patient might require surgical intervention to improve the airflow. In rare cases, the patient might need a lung transplant to restore quality of life and health.

Bronchial Asthma:

Asthma or bronchial asthma is a respiratory condition where the airways narrow down and get swollen, triggering the production of extra mucus. As a result, breathing gets difficult and leads to various other complications like severe wheezing, chronic cough, and shortness of breath. Asthma though a common condition, can cause a major disturbance in leading a normal life in certain individuals and may even lead to a sudden asthma attack that could be fatal.

The symptoms of asthma differ from person to person and are often prompted by external factors like seasonal changes, pollutants, and exposure to certain toxic gases. Asthmatic patients would need regular doctor consultations, especially during winter and seasonal changes, to combat it effectively.

What Are The Symptoms of Bronchial Asthma?

Bronchial asthma presents various symptoms and can vary from individual to individual. While asthma can be a chronic ailment for a few patients, other individuals might experience it suddenly while exerting pressure or working out. Allergy-induced asthma caused due to airborne components, including pollen, mold, and animal dander, can also interfere with lung function and trigger a sudden asthma attack.

However, the most common symptoms include the following:

• Shortness of breath
• Wheezing sound while exhaling
• Tightness and pain in the chest region
• Trouble sleeping due to discomfort in the chest, wheezing, and cough
• Frequent respiratory infections

What Causes Asthma?

There is more than one causative factor that can trigger an asthma attack. The list of common risk factors includes:

• Airborne substances like pollen, mold, pet dander, dust mites, cockroach waste
• Poor immunity that causes frequent respiratory infections like colds, cough
• Gastroesophageal Reflux Disease (GERD)
• Strenuous physical activity
• Cold air and extremely chilled weather conditions
• Emotional Stress
• Long-term use of nonsteroid, anti-inflammatory drugs
• Allergy to certain food items like nuts, processed foods, shrimp, and beverages

How Is Asthma Diagnosed?

Bronchial asthma is diagnosed by conducting various tests, including blood work imaging and other lung function tests. The most common recommended examinations include:

• Spirometry
• Peak flow
• Methacholine Challenge
• Sputum eosinophils
• Allergy tests

How Is Asthma Treated?

The symptoms of asthma can be controlled with the help of medication and making certain lifestyle changes. The doctor might prescribe the following depending on the severity of the condition:

• Inhaled Corticosteroids
• Leukotriene Modifiers
• Oral or intravenous Corticosteroids
• Shots to reduce the impact of allergens

How To Reduce Asthma Attacks?

• An asthma attack can be sudden and may need immediate medical intervention
• If you are an asthmatic, know your triggers. Always keep your asthma inhaler handy
• Do not get exposed to allergens, pollutants, and cold weather frequently
• If you are a smoker, quit immediately
• Keep up with your doctor’s appointments, and do not skip medication

Pulmonary Hypertension:

Pulmonary Hypertension is high blood pressure that happens when the pressure in the blood vessels from the heart to the lungs gets elevated. Pulmonary Hypertension causes the arteries in the lungs to narrow down, restricting the blood flow, thus resulting in less oxygen in the blood. This condition can further damage, block, and destroy the blood vessels building up the blood pressure in the lung arteries.

As a result, the heart bears the brunt and works harder to pump blood through the lungs, making it weaker. Pulmonary Hypertension can develop gradually in certain individuals, and the symptoms can be managed with the right kind of treatment.

What Are The Symptoms of Pulmonary Hypertension?

The signs and symptoms of pulmonary Hypertension can happen over a few months or even years. Talk to your doctor if you have noticed the following symptoms:

• Blue skin and lips, known as cyanosis
• Pressure and pain in the chest
• Shortness of breath
• Sudden dizziness and fainting
• Palpitations or fast heartbeat
• Edema or fluid accumulation in ankles, legs, and in the abdominal region

What Causes Pulmonary Hypertension?

Pulmonary Hypertension is classified into five groups, and the causative factors differ on the type of condition:

Pulmonary Arterial Hypertension:

• Genetic condition
• Congenital heart disease
• Prolonged use of certain medication
• HIV
• Liver cirrhosis
• Connective tissue disorders

Pulmonary Hypertension Caused by Left-Sided Heart Disease:

• Left-sided valve conditions such as mitral or aortic valve dysfunction
• Failure of the left ventricle

Pulmonary Hypertension Caused by Lung Disease

• COPD
• Pulmonary Fibrosis
• Sleep apnea

Pulmonary Hypertension Caused by Chronic Blood Clots:

Pulmonary embolism and other blood clotting disorders

Pulmonary Hypertension Caused by Other Health Conditions:

• Blood disorders
• Metabolic conditions
• Inflammatory disorders
• Kidney disease
• Tumours mounting against pulmonary arteries

Other risk factors include:

• Eisenmenger Syndrome
• Obesity
• Living at high altitude places

How Is Pulmonary Hypertension Diagnosed?

Pulmonary Hypertension is detected by running the following tests:

• Blood tests
• ECG
• Echocardiogram
• Right Heart Catheterization
• CT Scan
• MRI
• Lung function tests
• Ventilation Scan

How Is Pulmonary Hypertension Treated?

The symptoms of pulmonary Hypertension can be managed with the help of medications. Your doctor may prescribe you any one or more of the following medicines, depending on the severity of the condition.

• Vasodilators
• Guanylate cyclase (GSC) stimulators
• Blood thinners
• Calcium channel blockers
• Diuretics
• Oxygen therapy

Surgical Intervention:

Certain patients might need surgical procedures like Atrial Septostomy, heart-lung, or just a lung transplant to treat pulmonary Hypertension.

Interstitial Lung Disease:

Interstitial Lung Disease is an umbrella term used to describe a large group of diseases that cause slow and eventual scarring of the lung tissue. As the condition progresses, the functioning of the lungs gets compromised, causing severe breathing difficulties and restricting enough oxygen supply to the bloodstream.

There is no definitive causative factor behind Interstitial Lung Disease. One of the risk factors is continuous exposure to hazardous and toxic materials, while autoimmune conditions too can play a major role. Scarring of the lungs is irreversible, but medications might help in slowing down its progress and cause relief from the symptoms.

What Are The Symptoms of Interstitial Lung Disease?

• Severe shortness of breath while working and even at rest
• Continuous dry cough

What Causes Interstitial Lung Disease?

Long-term exposure to pollutants, toxins like asbestos, bird and animal droppings, history of radiation treatment, and silica and grain dust up the risk of Interstitial Lung Disease.

Prolonged use of medications prescribed for treating heart conditions, antibiotics, chemotherapy drugs, and anti-inflammatory medicines can make one susceptible to this condition.

Patients suffering from autoimmune conditions like rheumatoid arthritis, scleroderma, sarcoidosis, Sjogren’s syndrome, and mixed connective tissue disease are at risk of Interstitial lung disease.

If not detected and treated on time, Interstitial Lung Disease can lead to Pulmonary Hypertension, Respiratory failure, and right-sided heart failure.

How Is Interstitial Lung Disease Diagnosed?

Interstitial Lung Disease is diagnosed by conducting various examinations, including laboratory tests, imaging tests, spirometry and diffusion capacity test, and oximetry. Certain patients might need a lung tissue biopsy to understand the stage of the condition.

How is Interstitial Lung Disease Treated?

Your doctor might prescribe you the following medical treatments:

• Corticosteroid medication
• Oxygen therapy
• Breathing techniques to improve lung capacity
• Lifestyle changes

Surgical Intervention:

Patients suffering from severe Interstitial might need a lung transplant.

Treatment Modalities:

 ECMO:

Extracorporeal Membrane Oxygenation (ECMO) is a life support machine for critically ill patients suffering from heart and lung diseases. The ECMO machine takes over the role of the heart and lungs, and during the process, blood flows from the right side of the heart into the heart-lung machine, where the membrane oxygenator, rewarms, removes carbon dioxide, and supplies oxygen-rich blood back into the body. Since blood supply is done by bypassing the heart and lungs, these vital organs have enough time to rest and heal.

Who Needs An ECMO?

ECMO is recommended for patients who are critically ill due to severe heart and lung conditions. It is also needed for patients awaiting or recovering from a heart transplant. The support of this machine is pressed into action in the following conditions:

Lung Conditions:

• Acute Respiratory Distress Syndrome or ARDS
• Congenital Diaphragmatic Hernia
• Pulmonary Embolism
• Hantavirus Pulmonary Syndrome
• Pulmonary Hypertension
• Meconium aspiration in babies
• Pneumonia and Respiratory failure
• Trauma affecting lungs

Heart Conditions:

• Sudden, massive heart attack
• Cardiomyopathy
• Myocarditis
• Hypothermia or low body temperature
• Post-heart transplant in case of complications
• Cardiogenic shock
• Sepsis

How Does An ECMO Machine Function?

The ECMO machine is connected to the patient via cannula or plastic tubes, placed in large veins and arteries in the legs, neck, and chest. After connecting, the machine transforms blood from the patient’s body into an oxygenator which removes carbon dioxide and sends it back into the patient’s body, mimicking the function and force of the heart.

A respiratory specialist constantly monitors the patient’s condition on an ECMO machine to measure heart rate, oxygen levels, and blood pressure. The settings on the machine will be adjusted depending on the patient’s recovery.

The patient will be sedated to feel comfortable and will not feel any pain or discomfort. The ECMO support continues anywhere between hours to days and even weeks based on the heart and lung support needed.

Are There Any Side Effects To ECMO?

ECMO is a super advanced life support system. However, few patients may suffer from blood clots, infection, limb ischemia, and seizures. However, regular monitoring and prompt medication reduce the chances of complications significantly.

Bronchial Thermoplasty:

Bronchial Thermoplasty is a respiratory treatment recommended for asthmatic patients to relieve asthma symptoms. In patients with asthma, the airways narrow down and get swollen, leading to the production of extra mucus. This disrupts regular breathing and causes various complications like severe wheezing, chronic cough, and shortness of breath.

In bronchial thermoplasty, thermal heat is delivered into the lungs targeting the smooth muscles, preventing the tightening, thus bringing down the asthma symptoms.

Who Needs Bronchial Thermoplasty?

Bronchial thermoplasty is recommended for patients with severe asthmatic symptoms.

How Is Bronchial Thermoplasty Done?

Bronchial thermoplasty is a daycare procedure and is administered under mild anesthesia. A thin, flexible tube called a bronchoscope is inserted into the lungs via the nose or mouth, and the thermal heat is delivered to smooth muscles in the lungs through a thin catheter.

Many patients might need three sessions with at least three weeks gap between each session.

In each session, different sections of the lungs are treated.

What Are The Advantages of Bronchial Thermoplasty?

Bronchial thermoplasty significantly reduces the frequency of asthma attacks. The patient may still need medications but in a lower dosage.

Is Bronchial Thermoplasty Safe?

It is indeed a safe procedure. However, few patients may cough up blood or may encounter respiratory infections. Patients may experience some discomfort for a few days after the procedure.

Bronchoscopic Thermal Vapour Ablation:

Bronchoscopic Thermal Vapour Ablation is an advanced, cutting-edge Endoscopic Lung Volume Reduction (ELVR) that is aimed at the reduction of emphysematous hyperinflated segments, thus improving respiratory function in patients suffering from severe emphysema. The procedure improves pulmonary function in patients with or without collateral ventilation. BTVA is the first personalized treatment that facilitates targeted treatment at most diseased segments and also protects healthier segments from being unnecessarily reduced.

The surgeon, with the help of special software, identifies the targeted segments affected by the highest emphysema. Performed under general anesthesia, the surgeon positions the BTVA vapour catheter, guided bronchoscopically at the target segment and delivered the heated water vapour at the specified time and in precise dosage. The vapour is delivered between 3 to 10 seconds resulting in the ablation of the targeted diseased segments followed by a normal biological process.

This results in gradual volume reduction occurring over several weeks, even as it reduces the risk of pneumothorax. Reduction of hyperinflated segments allows healthier segments to expand, facilitating the retraction of the thorax and unflattening the diaphragm.

Is BTVA Safe?

Reducing the residual volume and improving FEV1 and SGRQ, BTVA is a boon for patients with or without complete fissures. There are no long-term complications, and it is considered an additional therapy for continued lung improvement and to better the quality of life. The patient will be monitored for a couple of hours after the procedure and discharged.

Medical Management of Pulmonary Diseases:

Apollo Hospitals, Bannerghatta Bengaluru, houses an advanced Interstitial Lung Disease clinic for patients suffering from various respiratory conditions. Severe pulmonary diseases demand round-the-clock monitoring and seamless medicinal and therapeutic support to ease breathing and ensure oxygen supply in patients combating various pulmonary conditions.

Scarring of the lungs is irreversible, and the patients awaiting lung transplants require extra care till the procedure is performed. The ILD clinic is helmed by eminent pulmonologists aided by radiologists, rheumatologists, nutritionists, physiotherapists, respiratory therapists for oxygen and device management, and pathologists for accurate diagnosis.

The clinic facilitates Pulmonary function test services, including spirometry, DLCO, 6MWT, and FeNo, besides echo. Imaging tests, including CT, CXR, and Ultrasound, are available. The respiratory therapists guide in rehabilitation while the physiotherapists and dietitians aid in simple exercises and dietary changes for faster recovery.

Biologics:

Asthma is a common condition, but it is quite severe in a few patients. Inhaler therapy significantly in reducing the symptoms of asthma but repeated usage of an inhaler can also flare up sudden asthmatic attacks.

The new injectable called biologic therapy is being administered to asthmatic patients as they target different immune cells in the body, triggering asthma, thus improving the quality of life.