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Tuberculosis (TB)

Management Team

Tuberculosis (TB)

Overview

TB is an infectious disease which primarily affects the lungs but can also impact other parts of the body. Importantly, TB can be fatal if treatment is not done on time.

Based on the organ affected, TB is of two types:

  • Pulmonary TB, which has lung involvement, comprises approximately 85% of all TB cases.
  • Extrapulmonary TB, i.e., TB involving organs other than the lungs, e.g., lymph nodes, abdomen, genitourinary tract, skin, joints and bones or meninges, comprises 15% of all TB cases.

TB is caused by the bacterium Mycobacterium tuberculosis. Risk factors include:

  • Close contact with TB patients

    Transmission: TB spreads through air when a person with active TB coughs, sneezes or talks.

  • Weakened immune system due to HIV/AIDS, diabetes, or any other immunocompromised condition
  • Malnutrition

  • Persistent cough (lasting more than three weeks)
  • Chest pain
  • Coughing up blood
  • Fatigue
  • Fever
  • Night sweats
  • Loss of appetite
  • Unintentional weight loss

Individuals should seek medical attention if they have symptoms like prolonged cough, fever and unexplained weight loss, as early treatment for TB can help stop the spread of disease and improve their chances of recovery.

Individuals should get tested for TB infection if they are at increased risk, i.e., if they have HIV or are in contact with people who have TB.

  • Chest X-ray is used to check for infection patches in the lungs.
  • Sputum test is used to examine mucus samples for TB bacteria.
  • USG, CT scan, MRI are also useful for diagnosing pulmonary and extrapulmonary TB.

Antibiotics: A combination of antibiotics (usually isoniazid, rifampin, ethambutol and pyrazinamide) taken over a period of 6‒9 months can help treat TB.

Drug-resistant TB requires treatment for 2 years. Patients should complete the full course of anti-TB treatment.

Prevention: TB infection can be controlled by wearing masks and ensuring good ventilation.

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Sleep-related Breathing Disorders

Management Team

Sleep-related Breathing Disorders

Overview

Sleep-related breathing disorders are a group of conditions characterised by abnormal respiration during sleep.

These disorders can range from simple snoring to more serious conditions like obstructive sleep apnoea (OSA), central sleep apnoea (CSA) and complex sleep apnoea syndrome.

  • OSA: This is the most common sleep-related breathing disorder. It occurs when the muscles in the throat relax excessively, causing a temporary blockage of the airways during sleep. Symptoms include loud snoring, choking or gasping sensation during sleep, excessive daytime sleepiness, morning headache, fatigue, irritability, memory lapses, resistant hypertension (requirement of three or more antihypertensive drugs). Untreated OSA can lead to uncontrolled high blood pressure, uncontrolled diabetes and increases the risk of stroke, cardiac arrythmias and cardiac arrest.
  • CSA: Unlike OSA, CSA is due to the brain failing to send proper signals to the muscles that control breathing. This results in periodic pauses in breathing during sleep. CSA is less common than OSA and is often associated with certain medical conditions, such as heart failure or stroke.
  • Complex Sleep Apnoea Syndrome: This condition is a combination of OSA and CSA. It can occur when someone being treated for OSA with continuous positive airway pressure (CPAP) therapy develops CSA.

  • Sleep history
  • overnight monitoring of your breathing and other body functions during sleep testing at a sleep center (Home sleep testing also might be an option)
  • Tests to detect sleep apnea include:
    • Nocturnal polysomnography. During this test, you're hooked up to equipment that monitors your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep.
    • Home sleep tests. These tests usually measure your heart rate, blood oxygen level, airflow and breathing patterns. Your provider is more likely to recommend polysomnography in a sleep testing facility, rather than a home sleep test, if central sleep apnoea is suspected.

For OSA:

  • CPAP therapy
  • Other airway pressure devices (auto-CPAP/BPAP) 
  • Oral appliances
  • Surgery

For CSA:

  • Treatment for associated medical problems
  • Medicine changes for managing breathing
  • Supplemental oxygen
  • Adaptive servo-ventilation (ASV)
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HbA1c Testing

Management Team

HbA1c Testing

Overview

HbA1c testing assesses the average levels of blood glucose over the previous 2–3 months, providing a picture of long-term glucose control. It is used to diagnose and monitor diabetes.

Elevated HbA1c levels suggest poor blood sugar management and a heightened risk of diabetes-related complications. The test is simple and doesn’t require fasting.

Managing HbA1c includes lifestyle changes like healthy eating habits, regular exercise, and medications to control blood sugar levels. Regular HbA1c testing helps patients and healthcare providers adjust treatment plans to achieve and maintain optimal blood sugar control.

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Sarcoidosis

Management Team

Sarcoidosis

Overview

Sarcoidosis is an inflammatory disease characterised by the formation of granulomas—tiny clumps of inflammatory cells—in various organs, most commonly in the lungs, lymph nodes, eyes and skin.

The exact cause of sarcoidosis is unknown, but it is believed to result from an abnormal immune response, possibly triggered by infections or environmental factors; it might also occur as a result of genetic predisposition.

  • General: Fatigue, fever, weight loss and night sweats
  • Lungs: Persistent cough, shortness of breath and chest pain
  • Skin: Rashes, lesions and nodules
  • Eyes: Blurred vision, eye pain, redness and sensitivity to light
  • Lymph nodes: Swelling, especially in the neck or armpits

  • Medical history and physical examination.
  • Imaging tests: Chest X-rays, CT scans to check for lung involvement.
  • Biopsy: Collection of tissue samples from affected organs to identify granulomas. Endobronchial ultrasound (EBUS)-guided biopsy of mediastinal lymph nodes or transbronchial lung biopsy using a bronchoscope are commonly done.
  • Blood tests: To check for signs of inflammation and organ function. Serum angiotensin-converting enzyme (ACE) levels may help in supporting the diagnosis.

  • Observation: Mild cases may resolve on their own without treatment.
  • Medications
    • Corticosteroids: They are the first line of treatment to reduce inflammation.
    • Immunosuppressants: For severe or persistent cases

Prognosis: The course of sarcoidosis varies widely. Some people experience only mild symptoms that improve on their own, while others may have chronic, severe symptoms that require ongoing treatment. In some cases, sarcoidosis can lead to complications such as lung fibrosis or organ damage.

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S

Respiratory Failure

Management Team

Respiratory Failure

Overview

Respiratory failure is a serious condition that makes it difficult to breath on your own. It develops when the lungs cannot transport enough oxygen to the blood.

Respiratory failure can be manifested through pneumonia, acute respiratory distress syndrome (ARDS), pulmonary embolism, COPD, neuromuscular diseases or severe asthma flare-ups.

Respiratory failure manifests as two primary types, i.e., hypoxemic and hypercapnic.

  • Hypoxemic respiratory failure or Type 1: Symptoms include rapid breathing, shortness of breath, cyanosis, confusion, and signs specific to the underlying cause, like fever in pneumonia. Diagnosis typically involves blood gas analysis showing low partial pressure of oxygen (PaO2) with normal or low partial pressure of carbon dioxide (PaCO2).
  • Hypercapnic respiratory failure or Type 2: Symptoms may include slower breathing, headaches, confusion, drowsiness and eventually respiratory distress. Blood gas analysis shows elevated PaCO2 and often low PaO2 in chronic cases.

Diagnosis of respiratory failure generally includes thorough clinical evaluation, encompassing evaluation of medical history, physical examination (lung auscultation, assessment of the respiratory rate), and imaging-based techniques like chest X-ray or CT scans to identify the underlying causes. Blood gas analysis plays a crucial role in confirming the type and severity of respiratory failure.

Pulmonologists in Management extend beyond their specialised medical expertise. They provide diagnostic precision through thorough evaluations, including PFTs, imaging studies, and interpretation of diagnostic tests. Pulmonologists collaborate closely with a multidisciplinary team of healthcare professionals, including intensivists, respiratory therapists and primary care physicians, to ensure coordinated and comprehensive care throughout the duration of respiratory failure, from acute stabilisation to long-term management and palliative care as needed.

Treatment of respiratory failure is a complex and multifaceted process that requires tailored approaches based on the specific type and severity of the condition. Central to this management is the role of a pulmonologist, a specialist in respiratory medicine who plays a crucial part in overseeing and coordinating the treatment plan.

  • Oxygen Therapy is foundational in managing hypoxemic respiratory failure, where inadequate oxygenation of blood occurs. Oxygen therapy is administered through various delivery methods such as nasal cannula, face mask, or mechanical ventilation.
  • Mechanical Ventilation becomes necessary in severe cases of respiratory failure, particularly when non-invasive methods are insufficient to support adequate gas exchange.
  • Management of Underlying Conditions is essential as many cases of respiratory failure stem from underlying respiratory diseases such as pneumonia, COPD flare-up or ARDS. This includes prescribing antibiotics for infections, bronchodilators and corticosteroids for obstructive lung diseases, and other medications tailored to manage the specific underlying cause.
  • Non-Invasive Ventilatory Support Strategies like BiPAP are employed for patients with hypercapnic respiratory failure, e.g., those with advanced COPD or neuromuscular diseases.

Long-term management involve pulmonary rehabilitation programmes that include exercise training, education on disease management, and strategies to improve overall respiratory health. Pulmonologists also emphasise lifestyle modifications such as smoking cessation and vaccination to reduce the risk of flare-ups and disease progression.

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Pneumonia

Management Team

Pneumonia

Overview

Pneumonia is an infection of the lungs that can be caused by bacteria, viruses, and fungi.

  • Pneumonia is most commonly caused by bacteria, particularly Streptococcus pneumoniae.
  • Other bacterial pathogens include Haemophilus influenzae and Staphylococcus aureus.
  • Viral causative agents include Influenza A (including H1N1), COVID-19, CMV a.

  • Fever
  • Productive cough with purulent sputum (often yellow or green)
  • Mostly dry cough during viral pneumonia
  • Chest pain, which may be pleuritic (sharp pain that worsens with breathing or coughing)
  • Shortness of breath
  • Malaise, headache and muscle aches

  • Chest X-ray typically shows a dense area of lung infection in one or more lobes of the lungs.
  • Blood tests may show elevated white blood cell counts.
  • Sputum culture can identify the causative bacteria.
  • Throat swabs can also be used for diagnosis.
  • Occasionally, CT chest and bronchoscopy are also required.

  • Pneumonia is treated with antibiotics that target common bacterial pathogens.
  • Pneumonia caused by viruses can be treated with antiviral medications.
  • Supportive care, including rest, hydration and symptom management, is also important for complete treatment.
  • Hospitalisation may be required for severe cases, especially in elderly or immunocompromised patients.

Yearly vaccination for must be done to prevent influenza. Pneumococcal vaccination is recommended for old age patients suffering from lung disease and immunocompromised individuals.

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Glucose Tolerance Test

Management Team

Glucose Tolerance Test

Overview

The glucose tolerance test (GTT) assesses how well the body processes sugar and is used to diagnose diabetes and Prediabetes.

It includes:

  • Fasting overnight (for minimum 8 hours)
  • Drinking a sugary solution
  • Having blood sugar levels checked at intervals

The entire procedure may take up to 3 hours.

A high blood sugar level after drinking the sugary solution indicates poor glucose metabolism. The test helps identify insulin resistance (when cells become resistant to insulin and fail to respond) and beta-cell (cells that make insulin) dysfunction.

It is especially used in diagnosing gestational diabetes in pregnant women. Understanding GTT results helps manage and prevent diabetes through lifestyle changes, medications, or other interventions.

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Pleural Effusion

Management Team

Pleural Effusion

Overview

Pleural effusion is the accumulation of excess fluid between the layers of the pleura, the thin membranes that line the lungs and the inside of the chest cavity.

Pleural effusion can be caused by various conditions, which can be broadly classified into transudative and exudative effusions:

Transudative Effusions:

  • Heart failure: Increased pressure in the heart and blood vessels
  • Cirrhosis: Reduced plasma oncotic pressure due to low albumin levels
  • Nephrotic syndrome: Low protein levels in the blood

Exudative Effusions:

  • Infections: Such as pneumonia or tuberculosis
  • Malignancies: Lung cancer, metastatic cancers
  • Pulmonary embolism: Blood clot in the lungs
  • Inflammatory conditions: Rheumatoid arthritis, lupus
  • Trauma: Injury to the chest

  • Dyspnoea (shortness of breath)
  • Chest pain: Often sharp and may worsen with deep breaths
  • Cough: Often dry may be productive
  • Fever: If the effusion is due to an infection
  • Hiccups: Due to irritation of the diaphragm

Clinical Examination: Decreased breath sounds, dullness to percussion and reduced tactile fremitus.

Imaging Studies:

  • Chest X-ray: Can show fluid in the pleural space.
  • Ultrasound: More sensitive for detecting small effusions and guiding thoracentesis.
  • CT Scan: Provides detailed images and helps identify the underlying cause.

Thoracentesis: Involves inserting a needle into the pleural space to withdraw the pleural fluid, which is then histopathologically analysed to determine the cause of the effusion and provide symptomatic relief to the patient.

  • Antibiotics: For bacterial infections.
  • Diuretics: For heart failure.
  • Chemotherapy/Radiation: For malignancies.
  • Antitubercular treatment: For TB.
  • Pleurodesis: A procedure to adhere the pleural layers together, preventing fluid reaccumulation. Often used in recurrent effusions, particularly due to malignancies.
  • Surgery
  • Pleurectomy: Removal of part of the pleura.
  • Indwelling Pleural Catheter: For periodic drainage of the pleural fluid.
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Pneumothorax

Management Team

Pneumothorax

Overview

A pneumothorax occurs when air enters the space between the lung and the chest wall, causing partial or complete lung collapse.

Pneumothorax can result from trauma/chest injury, such as a rib fracture; it can also occur spontaneously, particularly in individuals with underlying lung conditions like emphysema, COPD, pneumonia, or cystic fibrosis.

Symptoms include sudden chest pain, difficulty in breathing, and cyanosis.

Diagnosis involves a physical examination, chest X-ray, or CT to confirm the size and severity of the pneumothorax.

Small pneumothorax may resolve on their own, but larger or symptomatic ones may require treatment. Options include observation with supplemental oxygen to promote the reabsorption of trapped air, or chest tube insertion to remove air and allow the lung to re-expand. Surgery may be necessary for recurring or severe cases to prevent future episodes and complications such as tension pneumothorax, where trapped air increases the pressure within the chest cavity, potentially compressing the heart and lungs.

Treatment modalities for pneumothorax include:

  • Needle Aspiration: Inserting a needle into the chest cavity to remove excess air, similar to chest tube insertion but less invasive.
  • Pleurodesis: Creating inflammation and scar tissue in the pleural space (a thin space between the visceral and parietal pleura that lines the lungs and the chest wall respectively) using chemicals or talc to seal off the space and prevent recurrence.
  • Video-Assisted Thoracoscopic Surgery (VATS): Minimally invasive lung surgery using a small camera and instruments to view and treat the pneumothorax by removing blebs or sealing air leaks.
  • Lung Reinflation Techniques: Methods like high-flow oxygen therapy to reinflate the collapsed lung without surgery.
  • Preventive Measures: Preventive strategies, such as smoking cessation and avoiding activities that risk chest trauma are crucial for individuals prone to recurrent pneumothorax.

The choice of treatment depends on pneumothorax size, symptoms, and the patient's overall health.

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Gestational Diabetes Mellitus (GDM)

Management Team

Gestational Diabetes Mellitus (GDM)

Overview

Gestational diabetes mellitus (GDM) refers to a form of diabetes arising during pregnancy and usually resolves post childbirth. It is caused by hormonal changes occurring during pregnancy that tend to affect insulin sensitivity.

Often mild or absent, but GDM can lead to complications like high birth weight and preterm delivery (childbirth before 37 weeks of pregnancy).

Screening tests like the GTT during pregnancy.

  • Dietary changes
  • Regular physical activity
  • Sometimes insulin therapy to regulate blood sugar levels.
  • Monitoring blood sugar levels and following medical advice are crucial for a healthy pregnancy and reducing the likelihood of developing type 2 diabetes later.
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