Polio.The disease, virus, prevention and management

Introduction

The Polio virus is an organism,smaller than a bacteria which effects human nervous system cells. It multiplies inside the motor neuron cells of nervous system and totally destroys motor neuron cells. The destruction of motor neurons ultimately causes paralysis of various groups of muscles in human body. The virus gains entry into motor neuron cells by attaching itself to the cell receptors.After gaining access it multiplies into thousands in very short span of time, destroys the cell identity and takes the fucntion of parent cell.The polio virus has three variants, type 1,2 and 3.

What are the major muscles effected?

When polio virus attacks the spinal cord motor nerve cells, it results in paralysis or loss of abilty to move different muscles of arms, legs and respiration.This is medically termed as spinal polio.

When it infects motor neurons of eyes, taste, swallowing and breathing, it is known as bulbar polio. 

In certain cases it involves both spinal and bulbar elements of paralysis.

How Polio presents?

Polio virus infection  occurs in majority cases without any obvious sign or symtom of sickness.

Non-paralytic polio, is a form of polio virus infection where symptoms of flu appear, which last from few days to weeks. These signs and symptoms include fever, sore throat vomitting and headaches. Pain in neck, back and limbs with muscle spasms and tenderness may be predominating complains in some cases. Few of non-paralytic cases of polio develope meningitis, when infection spreads to membrane covering brain and spinal cord.

Paralytic polio has few of symptoms overlaping like non-paralytic variant. But it gets severe and causes impairment of motor functions. It usually is unilateral. There is pain in muscles of limbs, diminished or total loss of reflexes, spasm and ultimate flaccidity of limbs or muscles effected by polio viral infection. When muscles of respiration are infected, severe difficulty in breathing occurs, making survival more difficult. According to WHO every 1 in 200 cases with polio virus developes irreversable muscle paralysis.




Who is hit most by poliomyelitis?

Polio virus has prediliction for infecting children under 5 years of age. Of the % effected by polio virus, 99.5% do not get paralytic polio, only .5% progress to show signs of flaccidity of muscle/groups Other group most susceptable are pregnant women and individual with compromised immune system due to some disease process.

The mode of enterance of polio virus is through mouth. Contaminated water is biggest source of polio virus, which is excreted in faeces of polio infected individuals.

What are the risk factors?

Travelling to regions where polio virus infection is endemic.
Living in close contact with polio virus infected case.
Working in lab which handles live polio virus.
Tonsilectomized individuals.

How Polio virus infection is detected?

During first 3-10 days of illness polio virus can be isolated from oral scrapings.
Major diagnostic specimen is stool sample from individual showing acute signs of illness.
It is very rarely diagnosed from blood or CSF fluid exams.

Can polio be treated?

There is no known cure for any of variant of polio. When it is established that an individual has poliomyelitis, paralytic or non-paralytic, only supportive measure can substantially improve quality of life. For non-paralytic polio anti-pyretic analgesics help to control fever, headaches and associated muscle pains. That does not rid of polio virus from intestine of effected person.

Respiratory infection and breathing difficulty are the major problems to manage when respiratory muscle paralysis has occured. It may require instituting anti-biotics for chest infection and ventilator for maintaing respiration.

When paralysis is at earliest stage, applying plaster splints or sandbags for hip support at angle less than 10 degrees may significantly relieve  pain and prevent development of limb deformity.

 Physiotherapy is the core treatment strategy of paralytic polio. It involves hydrotheray,electrical stimulation of effected muscle/group and exercises.

Orthostatic appliances are placed over region effected, particularly upper leg to below the knee, to prevent angulation or deformities.

Prevention of polio

The standard oral polio vaccination is programmed to prevent infection from polio virus. Oral polio vaccine drops are given to kids from age 2,4 and 6 months with booster doses at age of 18 months and 6 years.Adults who have complete vaccination documentation during chidhood are considered polio virus immunized or free from virus and carry a life long immunity.

COPD, Life style,Support and Prevention

Life style factors, Support and Prevention

Your COPD (chronic obstructive pulmonary disease) has already jeopardized your well being. It has caused enough damage to your lung’s structure and function, which is irreversible. Now is the time to bring stability in your overall general health and pulmonary functions. This can be achieved by giving up habits and surroundings that have played a major role in causing your COPD. Following measure can help you halt the progress and improve your lung capacity and working.

Ÿ  Quit smoking, as it will stop further damage and help the medical treatment have its maximum effects. It will also reduce the effects of carbon monoxide in smoke on oxygen carrying of your blood. This toxic gas in smoke decreases red cells oxygen carrying capacity to your vital organs like brain and heart. The quicker you stop smoking the more faster your COPD disability starts stabilizing. If you find it difficult to stop smoking your health care provider may advise nicotine replacement substances (nicotine gums, patches, nasal sprays).

Ÿ  Avoid getting exhausted by resting when you feel out of breath or tired. Learn to exhale slow and longer, don’t put force into it. Your doctor will guide you some good breathing techniques to improve your early exhaustion and easy intake of fresh air. Pursed lip breathing is one such way to have better air entry which increases your lung capacity. Inhale deep and close your lips. Slowly exhale evenly through your pursed lips making whistling sound. Repeating the procedure 4-5 times will relieve your shortness of breath. This alone will gradually minimize breathing hardship. Learn to breath by using your diaphragm muscle. Inhale slow while you lie down, inflate your abdomen outwards. That brings your diaphragm down, making more room for your lung expansion. These techniques of breathing will increase your exercise tolerance as well as improve air entry in your lungs.

Ÿ  Eat well balanced and nutritious diet. This should have more fresh fruits and vegetables. Diet rich in legumes, nuts, meats will supply proteins. They will help you maintain good repair speed from COPD and make your muscle more stronger.

Ÿ  Fluids should be taken liberally. They keep a good hydration and make mucus in your airways less viscous. Less viscous mucus is easy to be coughed up and expelled to clear your airways.

Ÿ  Getting vaccinated will reduced the risk of further damage to your COPD effected lungs from viral and bacterial infections. Flu and pneumococcal vaccination generally help avoiding most common infection.

Ÿ  Keep yourself active socially by visiting friends and family members. This will lift up your mood which may generally get depressed by COPD handicap.

Ÿ  Avoid triggers like indoor or outdoor pollution. Cold dry weather and high altitude will make your breathing effort more tiring, keep away from such triggers. If your work has been with exposure to fumes and dust related industry, changing occupation will stabilized your COPD.

Ÿ  Good hygiene is best way to keep you clean and protected from common bacteria and viruses. Common liquid dish wash should be used, which has been proved to kill RSV(respiratory syncytial virus) very effectively, know cause of pneumonia.

Ÿ  Keep a lean and healthy weight. Obesity has negative impact on general health. It may further increase burden your compromised breathing and lung capacity. Reduce weight if obese or over weight.

Ÿ  Eat small and frequent meals. As eating large meals at one time is not possible due to breathing difficulty and general weakness of COPD. That will surely keep your nutritional status at healthy levels.

Coping and support

You should not let your suffering from COPD get the best of you. Since you are now under care of your doctor. Take it as a challenge and with his guidance you must learn to live with situation. You may at times feel severely depressed and disabled by COPD. But things like caring for your safety, communicating with your loved ones, joining groups with same problem. Share your thought and get to know anything on new treatment methods for COPD that may have beneficial effects. Knowing that you may get short of breath, take rest between chores. Don’t push yourself for hard tasks. Take physical therapist advise on degree of physical exertion you should be taking at a given pace and time.

Prevention

Smoking is the major cause of your COPD. It is also a well established fact that keeping away from smoking will not only prevent respiratory illnesses but many other health problems. Quitting smoking will bring some normalcy to your life if you have COPD. Quitting smoking is the single most benefit factor for your COPD, as it is the major cause of your health disability. Don’t smoke if you haven’t started, is the clear message you will get from your healthcare provider. As there may be some other reasons involved. Smoking will aggravate your disease.

Ÿ  Avoid fumes and dust and occupation place by taking standard safety measures. That includes wearing mask all the time while at work. Avoid second hand smoke by keeping non-smokers company.

Ÿ  If you have any sibling with history of COPD or alpha-1 antitrypsin  deficiency, you have greater risk of COPD development later in life. Get timely shots of deficient enzyme. Weekly I/V infusion alpha1-antitrypsin protein will bring its concentration in alveoli to normal. This will help in preventing development of COPD along with keeping away from smoking all your life.

6.0     Natural treatment

Acetyl-L-Carnitine.  

Acetyl-L-Carnitine, also called MRM, is an anti-oxidant with a basic form of L-Carnitine. Carnitine plays a major role in the conversion of body fat into energy. Beef is the highest source for carnitine, though there is no major dietary requirement as carnitine is essentially manufactured by the body itself. Carnitine helps improve the tissues ability to produce energy, thus theoretically supplemental carnitine can improve muscular efficiency. Due to this, carnitine is linked to treatments for angina, Alzheimer disease and COPD. A research conducted on 49 individuals in a blinded placebo-controlled study showed visible improvement in COPD tolerance(Dal Negro R, 1986). 

Boswellia

Arising from a family of trees in the Sapindales order, Boswellia is a plant used in many medications due to its anti-inflammatory properties. Trials on humans have revealed the effectiveness of Boswellia extracts for the treatment of patients suffering from rheumatoid arthritis, ulcerative colitis and COPD (Ammon HP, 2002). Compelling data shows that the boswellia extracts successfully inhibit 5-lipoxygenase, which is an enzyme that causes an inflammatory response in the body. On a long term treatment basis, Boswellia has not been shown to cause any adverse reactions as opposed to non-steroidal anti-inflammatory drugs (NSAIDs). Though future studies are needed to gauge the safety and efficacy of Boswellia with other remedies.

CoQ10 

Also known as vitamin Q10 and ubiquinone, CoQ10 is a co-enzyme, similar to a vitamin. It functions as an anti-oxidant helping the cells in the production of energy and also for cell maintenance. Supplements of CoQ10 help in improving your general cardiovascular health. Studies conducted on the efficacy of CoQ10 on smokers and patients with COPD has shown positive results. Patients suffering from hypertension and heart disease have markedly improved their exercise tolerance on the consumption of CoQ10 supplements. A study conducted concludes, “Oral administration of co-enzyme Q10 improved subjective fatigue sensation and physical performance during fatigue-inducing workload trials and might prevent unfavorable conditions as a result of physical fatigue” (Mizuno K., 2008).

Ginseng

Panax Ginseng is a perennial plant whose roots are used to treat various illnesses including COPD. When administered in patients during a study, ginseng was shown to have no side effects hence it is recommendable (Monaldi Arch Chest Dis. 2002 Oct-Dec;57(5-6):242-6). Since coughing and shortness of breath are the symptoms of COPD, the tonic made from the roots of ginseng is beneficial for the lungs and helps relieve them (collaborative study carried out by RMIT University, the Box Hill Hospital and Austin Health).

Omega-3

Found in oily fish such as mackerel and salmon, flaxseeds and flaxseed oil, omega-3 is acknowledged to improve the symptoms of COPD (Kagoshima University Hospital). Though COPD cannot be cured entirely, research proves that considerable relief can be provided to patients with COPD with the administration of omega-3. A diet rich in omega-3 lowers inflammatory cytokine levels  (Chest. 2005 Dec;128(6):3817-27).

Resveratrol

Chronic obstructive pulmonary disease (COPD) is mainly characterized by airway inflammation, which occurs due to oxidative strain in the body (Antioxid Redox Signal. 2010 Mar 9). Here, the role of resveratrol, being the antioxidant, becomes quite clear. Found in red grapes, berries and peanuts, resveratrol reduces inflammation and is known to be far more effective than corticosteriods in COPD treatment (J Pharmacol Exp Ther. 2010 Dec;335(3):788-98. Epub 2010 Aug 26). It also eliminates the production of interleukin in smokers with COPD by 94% (Thorax, October 2003).

Sulforaphane

Found in broccoli sprouts, Brussels sprouts and cabbage, sulforaphane contains disease-fighting compounds. It restores “antioxidant gene expression” in COPD (American Journal of Respiratory and Critical Care Medicine, September 2012). It is also known to reduce inflammation (Clinical Immunology, 2009). The supplementation of sulforaphane improves the macrophage phagocytic function of the lungs.

Vitamin D

Vitamin D is commonly found in tuna, salmon, sardines and milk but the easiest way to obtain it is to spend at least fifteen minutes in the sun daily. This vitamin is known to improve breathing for COPD patients (Thorax, 2010). Although vitamin D is commonly known to strengthen the bones, researchers believe it toughens the muscles too - thus, making it easy for patients with COPD to breathe. A study shows that high doses of the vitamin keep COPD patients’ health from worsening (Ann Intern Med. 2012 Jan 17;156(2):105-14).

Vitamin E

Since it has been established COPD is caused due to oxidative stress, vitamin E helps relieve the lungs of that stress because it is a natural antioxidant. Obtained from spinach, almonds, sunflower seeds, turnip greens, mustard greens, collard greens and bell peppers, vitamin E has been found to reduce the risk of COPD especially in women 45 years and older (researchers at Cornell University and Brigham and Womens' Hospital, April issue of Thorax, Vol. 66: 4). It improves the endurance capacity of DNA in the blood against COPD oxidation (Int J Vitam Nutr Res. 2007 Jul;77(4):272-9).

Zinc

Zinc is found in oysters, toasted wheat germ, veal liver, roast beef, watermelon seeds, pumpkin seeds, squash seeds, dark chocolate and crab. This mineral has anti-oxidative properties and promotes the betterment of a COPD patient’s health (Respir Med. 2008 Jun;102(6):840-4. Epub 2008 Mar 4). One study has concluded that supplementing zinc to COPD patients is helpful to counter the inflammation and airways restriction of this illness. It is based on finding of low serum levels, plasma levels and in hairs in patients with COPD. Zinc has been shown to keep a good balance between oxidant and anti-oxidant in your cells (Lang CJ, Bimetals published on 29 August 2010, sub. Of  dietry zinc and effects on inflammation).

Your COPD like so many other diseases is more preventable than treatable.The positive impact of quitting smoking or not smoking at all, getting alpha-1 anti-trypsin for compensating its lack, maintaining diet rich in vitamin sources and in case of any deficiency using supplements, are all measures which can help you prevent this debilitating illness.

COPD, complications and pharmaceutical therapies.

Complication

Chronic obstructive pulmonary disease is serious and debilitating health problem. It runs a long course to cause severe damage to your lungs. Its diagnosis and treatment usually starts when it has already caused secondary complication to your cardio respiratory system. Your lung capacity is markedly diminished as well as life routine compromised. The complication can be life threatening if exposure to causative agents is not avoided and supportive treatment not taken. Following secondary effects of  COPD may endanger your life;

Ÿ  Pulmonary hypertension arises when your lungs loose elasticity along with constriction and hardening of its blood vessels as result of COPD. Heart faces greater resistance to push blood into pulmonary artery, through your lung vessels. Ultimately oxygenation of blood is reduced.

Ÿ  Pneumonia of both viral and bacterial cause may readily effect you in COPD. The dual effect of reduced oxygenation and excessive mucus in airways makes your lungs more susceptible to infection by such organisms. Deterioration in your health due to COPD hampers or minimizes your immunity. Pneumonia further damages your lung tissue which is already facing restrictive effects of COPD, thereby creating a vicious cycle.

Ÿ  Cor Pulmonale is failure of right side of your heart due to chronic obstructive pulmonary disease. There is increased resistance faced by right ventricle of your heart in pumping blood through lungs. Pulmonary artery pressure rises and ultimately results slow pumping, lesser blood flow to lungs and breathing strain. Right ventricle enlarges and fail to work efficiently.

Ÿ  Polycythemia (increased red cells in blood) occurs due to reduced oxygen saturation of blood. It stimulates your bone marrow to produce increased number of red blood cells. This is mediated via erythropoietin(hormone for red cell production) release from your kidneys. The objective is to compensate reduced oxygen supply to your body cells as complication of COPD sets in.

Ÿ  Malnutrition and weight loss is very common when you have established COPD. The dyspnea (difficulty in breathing) is so troublesome that will make it hard for you to complete a meal. You may gradually start loosing weight. This further effects your body strength to carry out routine life activities.

Ÿ  Pneumothorax is presence of air between your lungs and chest wall. The over inflated air sacs in emphysema (COPD variant) may burst with result in escape of trapped air into chest cavity. This complicates into collapse of your lung if that air is not immediately removed from you chest wall through intubation.

Pharmaceutical therapies

The damage your smoking has caused during long term is irreversible. Any treatment at this stage will be supportive and not curative. The medicine and other modalities will halt progression of damage, enhance your strength needed for daily life activities to better extent. Following are medication that will be prescribed when you are diagnosed with COPD.

                                                                            Bronchodilator inhalers

                                                  

Ÿ  Bronchodilators,  are group of drugs that will relax and expand the constricted and narrowed respiratory passages. They can be taken orally, by injections or as aerosols/inhalers. The inhalation route of bronchodilators is much preferred as it effectively reaches the narrowed airways directly with immediate effects. Also the side effects associated with drugs are minimal. A combination inhaler of fluticasone and salmeterol is one of popular inhalers for COPD. Another inhaler to be prescribed contains formotorol and budesonide. They all have corticosteroids and long acting b agaonist bronchodilator. You may be given oral long or short acting beta agonist like albuterol, turbutaline, salmeterol, bambuterol, formoterol.

Ÿ  Side effects of beta agonist agents include ; tachycardia(rapid heart rate), tremors, premature ventricular contractions, sleep disturbances, lowering of serum potassium.

Ÿ         Anti-cholinergic inhaler may also be given. Ipratopium is one of such kind. They all have proven efficacy in your COPD maintenance treatment. They also relax the smooth muscles of your airways and reduce mucus secretions. These agents improve your exercise tolerance and forced expiratory volume in one second. They are prescribed to you if you have some underlying cardiac problem. Side effects of anti-cholinergic are, dryness of mouth, increased intraocular pressure.

Ÿ  Methylxanthines are group of drugs that have some bronchodilator effect. They also make mucus expulsion easy and strengthen airways in some way. Theophyline(oral) and aminophyline(inject able) are two agents of this group used.

Ÿ  Side effects of methylxanthines are, irregular heart beats, convulsions, headache, nausea, vomiting, diarrhea and heart burns.

                                                       

Ÿ  Corticosteroids,   such as prednisone and prednisone are very effective anti-inflammatory group of drugs for your COPD. They bring satisfactory improvement in lung function in 30%-40% of COPD patients. They reduce inflammatory reaction, hall mark of swollen respiratory passages and excessive mucus.

Ÿ  Side effects are, osteoporosis( thinning of bones), raised blood pressure, disturbed sugar levels leading to diabetes on long term use, weight gain, loss of sleep.

Ÿ  Vaccination, to minimize risk of flu and pneumonia. Flu shots are better to be taken with full consultation of your healthcare provider as they have shown aggravation of COPD. Pneumoccocal vaccine also decreases you risk of pneumonia, which may complicate your COPD easily.

Ÿ  Oxygen therapy,  may be needed to bring improvement in its concentration in your airways. This is highly reduced in COPD. It can benefit in your daily activity. Also it will be preventing heart strain and damage to vital organs. It brings about improvement in your sleep and keeps your energy level high.

Ÿ  Anti-biotics,  also have an important role to play in controlling infection in your COPD. These infections easily can harm your lungs. In acute flare ups of your COPD, the number one choice is tromethoprim-sulphamethaxazole combination for five days. Other group also effective are ampicillin and tetracyclines for same duration. Azithromycin has also shown promising results in dealing infection in COPD.

Ÿ  Side effects of anti-biotics are common with gastrointestinal upsets, skin rashes, vomiting , nausea, abdominal pains. Some of them may cause anaphylaxis, a sudden and possible life threatening reaction drug.

Chronic obstructive pulmonary disease (COPD)

                                                                              Emphysema

 Chronic Bronchitis

Introduction

Chronic obstructive pulmonary disease also know as COPD, is chronic debilitating disease of your lungs. The condition is characterized by difficulty in your breathing associated with constant cough productive of thick mucus. It is caused most commonly by smoking and continues to progress in severity with more and more difficulty in your breathing ability and reduction in lung capacity. Chronic bronchitis and emphysema are two condition which mainly come under same definition of COPD, along with asthma. The common feature is reduced oxygen intake and carbon dioxide expulsion. This makes you  breathless or short of breath most of the time.

In chronic bronchitis there is distortion of your bronchial passages.Whereas in emphysema the alveoli of your lungs are enlarged with loss of their expandable quality. Other than smoking, your exposure to any irritant dust, chemicals can cause such damage leading to COPD. The damage to your lung tissues in both condition, chronic bronchitis and emphysema is irreversible. But if the insulting or the causative irritant is removed, further damage can be controlled. You may develop features of chronic bronchitis and emphysema at same time, if you continue smoking for longer duration.

Ÿ  Incidence; COPD worldwide is 4^th most common cause of death. Whereas in US alone ,it is 3^rd most common cause of death in both males and females. An estimated 16 million individuals are presently effected in US with chronic obstructive pulmonary disease (COPD). COPD is mostly encountered in smokers of 60 years and above age.

Ÿ  About $33 billions have been spend on healthcare of patients with COPD in US. More females are hospitalized than males due to this debilitating pulmonary disease.

-           Major symptoms that may effect you in COPD are, long standing cough with thick productive sputum, increasing difficulty in your breathing efforts, which is more marked when you indulge in exercise. With progress of COPD even exertion of simple nature like changing cloths or cooking. You may start loosing weight.

Causes and Risk factors

The principal/major cause of your COPD is extended or long term exposure to smoke or smoking. If you are involved in occupation which exposes you to irritant dust or fumes, you will have changes in your bronchial passages and smaller airways. These will lead to chronic obstructive pulmonary disease. The conditions of chronic bronchitis, chronic asthma and emphysema are grouped as COPD. They may co-exist in same individual. The morphological changes in your lungs, caused by smoking or getting exposed to second or passive smoke or chemical fumes are, loss of elasticity of your airways(bronchi) and air sacs (alveoli). Air  passages get swollen and inflamed filled with mucus, walls between air sacs are destroyed with loss of surface area of ventilation. These all will lead to reduction in oxygen intake and exertional effort for breathing to compensate.

Ÿ  Chronic bronchitis with or without asthma may lead to narrowing of your bronchial passages. This condition is further aggravated by excessive secretion of mucus due inflammation caused by smoke and other irritants reaching your airways. Asthma ,if it is not well controlled may lead to COPD with remodeling of lung tissues. Although the precise mechanism in both condition is quite different. In COPD, there is more of neutrophilic reaction involved, whereas asthma is characterized by eosinophilic response. Wheezing is common in both the conditions. The major difference between asthma and chronic bronchitis causing COPD is, the reversible narrowing of airways in your asthma.

Ÿ  Emphysema is another condition causing chronic obstructive pulmonary disease. Your lungs exposed for years to smoking or secondary smoke cause damage to smaller air sacs called alveoli in your lungs. Walls separating adjacent alveoli breaks down due to inflammatory damage and accompanying cough. Larger sacs are created which trap the air in them. The loss of exchange of oxygen and carbon dioxide results in your breathlessness. This situation over period of time becomes severe and irreversible. Your smoking and other irritants cause activation of macrophages in your alveolar cells. The macrophage response causes neutrophilic chemotactic factors release. Which in turn release protease, that breaks down alveolar tissue, resulting in your emphysema.

Risk factors

Your chronic obstructive pulmonary disease is one of world’s top five leading cause of death. The most difficult aspect of getting this debilitating illness treated early is, its slow and camouflage (hidden) progress to severity. With this fact in consideration the risk factors may guide in  preventing your ongoing lung insult and progress to COPD.

Ÿ  Smoking is one major risk for your respiratory handicap due to chronic bronchitis, emphysema, and chronic asthma (COPD). The earlier you start smoking and longer you have continued, is a major determinant risk for COPD. Even as passive smoker, how long you have been exposed to second smoke will put you in risk for either one of COPD variants. In as much as 80% to 85% of diagnosed COPD effected individuals, smoking is sole causative factor found. The number of cigarettes you smoke daily also determines your severity of COPD. In addition to cigarettes, cigar, pipes, and marijuana also increase the risk in your lung disability due to COPD.

Ÿ  Pollutant exposure will also play risk factor for COPD. If place of your work or residence is close to industrial unit’s the fumes and dust will increase your COPD risk. Exposure to biomass fuel in cooking enhances your chances for COPD development greatly if care is not taken.

Ÿ  Genetics may also make you more susceptible to get any of COPD conditions. COPD runs in families who have shown deficiency in a-anti-trypsin deficiency. This enzyme factor is produced by liver and it protects your lungs from damaging effect protease enzyme. Its deficiency may cause alveolar wall destruction specially in smokers, resulting in emphysema. When you have any of first blood relative with COPD, your smoking adds to greater risk.

Ÿ  Gender risk now has shifted towards females in COPD occurrence. Women are now shown to be more effected by negative influences of smoking on their lungs than men.

Ÿ  Lower socioeconomic status is more risk for development of COPD for obvious reasons. Lack of safety measure during using biomass fuel cooking methods, failure of early treatment of chronic respiratory illness. All will contribute to COPD at later age of life.

Ÿ  Preterm birth history means that after birth you must have received oxygen therapy. This method of artificial oxygenation will damage your lungs and increase COPD at advance age of your life.

Ÿ  Asthma has been linked to COPD, as it may cause permanent bronchial restriction to breathing. This may result if you are non-compliant to treatment and preventive measures.

Breast Cancer

ductal carcinoma in situ

Introduction

The carcinoma or cancer of the breast is the most common and sometimes life-threatening malignancy in females. Although it also occurs in men but on very rare instances. Most frequently effected tissues of breast that turn into cancerous growth are ducts and lobules of breast. It is still the major cause of death due to cancers in females after skin malignancy. The growing awareness and screening of breasts lumps or otherwise has helped greatly in fight against this killer disease. This has lead to treatment at earliest stage of breast cancer, which yields best results. This has also greatly improved survival rates of breast cancer patients.

The improvement is attributed to surgical and other therapies of your breast cancer at stage when it has not spread. It is also important to note that diagnosis of your breast cancer at younger age has also been contributory for such remarkable prognosis.

The statistic from US reveal that an estimated 2,25000 females and 2000 males have been newly diagnosed from breast cancer.

Ÿ  Symptoms of breast cancer

You may be diagnosed for breast cancer before any symptom being noticed. Mammography or feeling of lump may disclose that you have cancer in your breast. You may rarely discharge from one breast which may or may not be bloody. Both these situation merit detail investigations. Sudden change of breast texture, redness of skin over your breast or wrinkling may need evaluation.

Ÿ  Types of breast cancer

-           Invasive breast cancer is type which has spread from duct or lobule to other breast tissues. Noninvasive is called breast cancer in-situ. The common types are;

-           Ductal carcinoma in-situ is intraductal breast cancer that is localized to ductal linings.

-           Lobular carcinoma in-situ is located in milk producing cells of breasts.

Both these types of breast cancer although localized may spread to surrounding breast tissue or other parts of your body if untreated.

Breast cancer stages

Causes and Risk factors

Like most of cancers effecting general population, cause of breast cancer have also not been established so far. The basic change in cellular proliferation starts in either the ducts or lobules of  your breast. Excess rate of breast cell growth results in tumor formation. The spread of such cancerous growth from your breast  is not uncommon. Following are the most probable and common risk factor responsible for your breast cancer development;

Ÿ  Age is most relevant factor in your breast cancer development. Although young age females may be effected, but your chances of having cancer of breast increase with age. If you are a woman of 40 years plus, you carry one in 70 chance, whereas at 60 years it becomes as frequent as one in 30 chance in coming ten years. Beyond 50 years your breast cancer may be far advanced at the time of diagnosis.

Ÿ   Being a woman of white race will put you at more risk then African or black colored female. Previous history of breast carcinoma in one  breast will put you at four times more danger of malignant growth in other side or a second cancer in same breast.

Ÿ  Genetic predisposition has great impact in development of your breast cancer. It is estimated that about 5-10% of  breast cancer have genetic links. The risk is carried to you from both sides of family tree. First or second degree relative from father or mother side, any of siblings (mother, sister or daughter) who have or had breast cancer will make your breast cancer chances high. Younger the age the greater the risk. Even if you are a male with rare breast cancer, you may put female member at breast cancer risk. The gene defect is identified and implicated in your breast cancer are BRCA1and BRCA2 (breast cancer gene 1 and 2).

Ÿ  A history of ovarian cancer, endometrial cancer will enhance your breast cancer risk. Even if you have a past removal or treatment for benign breast hyperplasia, fibro adenoma, radial scar that will increase your risk of breast cancer.

Ÿ  Early menarche or late menopause make your breast cancer risk greater through hormonal influence. If your first period started at the age of 12 or you menopause at 55 or beyond have regular check on change in your breast structure for any lump. This has been attributed to your longer exposure female hormones estrogen.

Ÿ  Getting pregnant at earlier than 30 years will reduce your breast cancer risk. But if you are nullipara (never borne a child) during fertile period of life, you will have breast cancer risk at older age.

Ÿ  Hormone DES (diethyl stilbestrol) when given to you during pregnancy to prevent miscarriage, premature labor has been shown to increase breast cancer development chances.

Ÿ  Alcohol consumption of more than 1-2 drinks/day will be a risk in your breast cancer growth. This is influenced possibly through increased estrogen levels. More effected by this risk factor are women at older age group as heavy drinking is more commonly found in older age. It has been studied that your risk of lobular carcinoma is increased by 63% as compared non-alcoholics (Women’s Health Initiative, WHI study 1993-1998).

Ÿ  Exposure to DDE (dichlorodiphenyldichloroethylene) an insecticide, increases your chance of breast cancer.

Ÿ  If you belong to higher socioeconomic group you run more risk of breast cancer development than woman of lower socio strata. As early cessation of breast feeding is more observed in former class than later.

Ÿ  HRT (hormone replacement therapy) will be given to you for your post menopausal symptoms for several years. This will increase risk, if combination preparation of estrogen and progesterone are taken rather than estrogen preparation alone (women’s health initiative study).

Ÿ  Obesity increases your breast cancer development chances. It is shown that taking more fats in your diet somehow put your risk at higher degree.

Ÿ  Exposure to radiation of upper part of chest if done at younger age may bring breast cancer after quite many years. It may be done to treat some kind of cancer like Hodgkin’s lymphoma.

Ÿ  Physical inactivity will make you more susceptible to develop breast cancer. A study by Women Health Initiative (WHI) has indicated that regular exercise of 1 ½ hrs- 2 ½ hours will minimize your risk of breast cancer by 15-18%.

Asthma

Introduction

Asthma is described commonly as the chronic inflammatory (long standing) disease of your respiratory passages. This inflammation results in the spasm of bronchial passage (respiratory air ways) and the production of excessive mucous from their cells along with swelling. The whole cycle of events may cause a feeling of tightness in your chest with breathing difficulty, repeated cough and a wheezing sound (whistling sound) on auscultation of chest.

The severity of an asthmatic episode can range from a feeling of mild breathing difficulty to an uncontrolled asthmatic attack (status asthmaticus) in which case treatment modalities fail to give response and asthma may become fatal. Although, so far your asthma hasn’t gotten a complete cure but with a wide range of drugs and treatment options available, your symptoms can be controlled well and return to their normal breathing pattern. In maintaining your asthma to good control, it is important to be compliant with your doctor in consultation and managing dosage of medications.

Causes and risk factors

The predilection for having asthma is still to be specifically known. But two major factors, which hold the key as to the provoking or stimulating an attack of asthma, are environmental pollutants and genetic predisposition. When dealing with asthma there will always be either of these or both etiologies playing role as triggers. Although it can effect individuals of either sex or age, asthma is encountered more commonly in children under the age of 18 years. There is no general rule as to what might provoke asthma in you and not in others.

Asthma triggers :

·         Environmental allergens like pollens, house dust mites, cockroaches, pet animals like cat and dogs’ dander, rodents and mould can provoke asthma.

·      Infection: Viral or bacterial upper respiratory tract infection quite often trigger an asthmatic attack. A mild cold is what it appears in beginning progressing to full blown asthma with wheezy chest. Industrial and chemical fumes are easily blamed for asthmatic symptoms termed as occupational asthma.

·      Exercise induced asthma:  Physical exercise specially in cold weather conditions easily provoke mild to severe attack. The triggering factor is dry inhaled air stimulating allergic reaction and bronchospasm.

·       Food consumed: In certain individual specific food can trigger asthma. The likes of shellfish, peanuts are leading food items notified. In some even eating eggs, fish and wheat can elicit asthmatic attack.

Food preservatives can trigger asthma, such as sodium bisulfite, potassium bisulfite and sodium sulfite found in dried fruits or vegetables, pickled food, wine and beer.

·     Drug induced asthma:  Commonly used anti-inflammatory analgesics drugs like aspirin, ibuprofen, and beta blockers result is asthma  in person having history of allergies.

·       Stress and emotion  :   Getting angry at social or work issues, receiving a good or tragic news, can all lead to provoking an asthmatic attack. In women during menstrual phase symptoms of wheezing and cough may progress into full blown asthmatic situation.

·    Gastro-esophageal reflex disease(GERD): With symptoms this can damage respiratory passages and incite asthma.

Risk Factors

 ·       Genetic predisposition, means if a child has either or both parents or any of brothers or sister suffering from asthma ,the chance of  asthma effecting that child will increase.

·        Atopic individual, are those who have greater tendency of having different sorts of allergic condition like hay fever or atopic dermatitis or allergic rhinitis. These individuals are more susceptible to develop asthma at any stage during life.

·     Smokers and those exposed to passive smoking or occupational fumes can easily get triggers for their asthma. The most damaging aspect of this risk factor is irritant to moist respiratory mucosa along with damage to cilia of airways.  Excessive mucous production in one hand and failure to sweep that outside the passages adds to aggravate asthma.

·      Women smoking during pregnancy will deliver premature low birth baby. This in turn puts the child into more risk. A study carried out at division of pediatric pulmonology  (Orlando florida pediatric clinics) have concluded a strong association between low birth weight and asthma risk.

·    Obesity & asthma association is well documented. Asthmatic overweight show improvement in their symptoms when they loose weight. It may have genetic , gastro-esophageal reflex, low physical activity and diet as co-factors.

3.0   complications

Poor asthma control gradually results in permanent lung damage and following complication :

·    Disturbed routine: A persistent cough and wheeze makes life miserable and uncomfortable to the extent, that sleep and day time activity is disturbed. Be it work or recreational, carelessly handled asthmatic becomes breathless with slightest of physical exertion as lung function have been compromised with lack of treatment compliance.

·      Work and study absence : Failure to follow treatment plan results in persistent symptoms and frequent flare ups. Inability to focus at work and study interferes in continuity and absence.

·      Altered airways anatomy/airway remodeling  :     Poor control results in permanent narrowing of respiratory bronchi. Continues inflammation and lack of mucous drainage is the main cause of such change. Narrowed airways result in more frequent attacks , further aggravate the situation.

·       drugs side effects  : whether inhaled or oral steroids their long term use can have deleterious effect on general health.

·        Status asthmaticus  : Most severe form of asthma ,which if not controlled well in time proves fatal. The airways are so much narrowed that breathing in and out becomes minimal. With so much awareness and advancement in treatment option this complication has become rare.

4.0 Pharmaceutical therapies

Like all the other chronic(long standing) illnesses, the pillars on which good asthma control stands are preventive measures and compliant to drugs prescribed. Knowing your asthma triggers , keeping them at bay, watching out your airway status through home peak flow meters are measure playing major role in better control.

Prescribed medication for asthma  :    The main criteria for medical treatment you will be  given are following :

Your age.

Severity of  your symptoms.

Your asthma triggers.

What agent suits you best.

Long term preventive medication are best suited as they keep inflammation in control. And there are drugs available for any acute severe attack.

Medicine for long term management : As we have come to know ,preventing asthma attack will gradually increase lungs capacity and bring improvement in their function, these long term medicine usage is the mainstay of your asthma control. They are to be consumed on daily basis which keeps a check on acute episodes.

·        Inhaled steroids : Before the advent of inhalation steroids ,oral steroids were giving serious systemic side effects. That has been minimized when steroidal anti-inflammatory agents just act locally without significantly getting absorbed to produce much ill effects. They are to be taken daily. Included are: Fluticasone,Budesonide, Ciclesonide,Flunisolide

Beclomethasone and Mometasone.

Generally safe for long term use, some minor side effects have been observed with inhaled steroids. Risk of oral thrush, a fungal infection of mouth,  hoarseness of voice due to effect on vocal cords. In children growth retardation has been noticed but that is well compensated during growth catch up phase. Osteoporosis , a bone demineralization , a side when high doses of inhalations are taken. Cataract and glaucoma are other side effects notified in elderly asthmatic.

·        Leukotriene Modifiers. Included in this class are : Montelukast, Zafirlukast, Zileuton .

Zafirlukast reduces hyper-responsiveness of airways to histamine, Zileuton has its effect in allergic-induced airways response. These agents have long duration of action lasting 24hours. The side effects are, aggression, hallucination, agitation, and suicidal tendencies. Any untoward side effects must be reported to your doctor.

·        Long-acting beta agonist.  They are commonly known as brochodilators. They dilate or open the narrowed airways . They too are to be taken as inhalation. Included in this class : Salmeterol Formotrol, Bambuterol.. There is warning in their usage as they may aggravate an asthmatic attack, hence they are to be taken in combination with inhaled steroid. The duration of their action on respiratory passages last for almost 12 hours. Although they ease breathing effort but when you will be exposed to irritants they fail to control they excessive mucous production and swelling within respiratory airways. Deaths have been reported in LABA’s use as single drug therapy.

·       Combination Inhalers : They are combination of inhalation long-acting beta agonist and steroids. Included are Fluticasone-Salmetrol, Budesonide-Formoterol, and Mometasone-Formoterol combination. They exhibit side effects similar to when used as single agent but higher doses of steroid can avoid more serious side effect of fatality. Only used in case when steroid alone are giving good control of your asthma.

·        Theophyline  : It is bronchodilator, which opens the airways and relaxes labored breathing efforts . But in recent years its used is not so common.  Side effects include irritability, headache , nausea, sleep disturbances, diarrhea, restlessness and increased frequency of urination.

Life saving fast acting drugs : 

They may be needed for short term and rapid relief of symptoms, before indulging in sports activity or work of physical nature and during an acute asthmatic attack, hence termed “rescue medicine” . Following are some effective medicine for purpose mentioned :

·          Short acting beta agonists :  The big advantage they will give you is to act fast and control the troubling symptoms immediately. Best taken just before exercise ,taking showers or going out in cold weather. Albuterol , Levalbuterol, Pirbuterol are used presently with good results. Commonly taken via portable nebulizer as mist vapors, or hand managed inhaler. Side effects include skeletal muscle tremors, tachycardia, nervous and shakiness and sleep disturbances.

·        Ipratropium, is anti-cholinergic agent, which has property of relaxing brochial smooth muscles and easing breathing. But it is not preferred over other quick or rescue medicine before exercise or during an acute asthmatic attack. Side effects are dry mouth and increase in wheezing. Ideally this drug is given with short acting beta agonist.

·       Oral and inject able corticosteroids :  They are used on short term basis due to their strong anti-inflammatory ,anti-allergic effect in asthmatic. But side effects limit their use on long term basis. The commonly use steroids are prednisone and methyl prednisone and inject able triamcinolone. Side effects they exhibit are, increase appetite, weight gain, increase blood sugar in diabetics ,mood changes, rise in blood pressure in hypertensive, worsening of CCF(congestive cardiac failure), osteoporosis and sympathy.

Quick relieving medicine are not to be used when you have satisfactory control with your long term daily medication.

Allergic medication

·        Allergy shots : Also termed immunotherapy, are preparation of substances with whom you are allergic. They are injected in small doses after careful skin testing. Weekly shots are given with gradual increasing dose for 4-6 months. The idea behind such therapy is to make your body less responsive to some particular allergens.

·       Omalizumab(Xoliar) : This substance given as injected form if you have allergic asthma all year round. Suited for individual 12 years and above. If your symptoms are not well controlled by long term asthma drugs then this agent can be effective in reducing frequency of acute asthmatic attack. A prior test dose is give at doctor’s office before full dose. Severe anaphylaxis(extreme to substance) has been reported. You should be observed at doctor’s office for few hours after injection of Xoliar.

·        Allergic medication : cromolyn sodium nasal spray can be used . So are the different anti-histamine available OTC. They prevent and relieve symptoms of rhinitis that can subsequently lead to asthmatic symptoms. Decongestant and corticosteroids nasal are effective in hay fever and common cold. Side effects include, burning and stinging sensation in nose.  Unlikely side effects are headache, dizziness, heart pounding ,sleep trouble, body tremors .