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Electromyography (EMG)

Management Team

Electromyography (EMG)

Overview

EMG is the other component of NCV, which is used to record the baseline muscle activity, motor units, and recruitment of multiple motor units on complete stimulation.

It is helpful in differentiating between disorders of lower motor neuron disorders such as anterior horn cell, nerve, neuromuscular junction, and muscles.

  • A thin needle electrode is inserted in the muscles
  • Muscle activity is studied

  • Diagnosis of muscle dystrophy and other muscle diseases
  • Evaluation of muscle weakness or paralysis
  • Single fibre EMG for neuromuscular diseases
  • Evaluation of peripheral neuropathy/ radiculopathy/ nerve compression/ entrapment
  • Establishing diagnosis of anterior horn cell disorders
  • Evaluation of cramps/ spasms/ tremors
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Nerve Conduction Velocity (NCV) Studies

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Nerve Conduction Velocity (NCV) Studies

Overview

It helps in evaluating conduction in various large peripheral nerves in our body. The latency, amplitude, and conduction velocity are calculated for the nerve under investigation. A decrease in recorded amplitude implies damage to the axons of the nerve (axonal neuropathy). If the myelin sheath surrounding the nerve gets affected, the nerve conducts the electrical impulse slowly and its conduction velocity decreases. This is seen in demyelinating disorders. Both motor and sensory component of the nerves are studied using this method.

  • Electrodes are placed on the extremities to be studied
  • The nerve is then stimulated via a stimulator by giving a low voltage current
  • An electrode placed at the other end of the nerve records the response

  • Diagnosis of peripheral neuropathy
  • Evaluation of nerve injury
  • Diagnosis of nerve compression or entrapment syndromes
  • Monitoring nerve function in chronic diseases such as diabetes and kidney diseases
  • Evaluation of numbness or weakness
  • Diagnosis of nerve root lesions
  • Pre-surgical evaluation
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Electroencephalography (EEG)

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Electroencephalography (EEG)

Overview

Electroencephalography is a non-invasive (painless) neuroimaging technique that measures the electrical activity of brain through electrodes placed on scalp. The activity in the brain evolves as the brain develops. In a sleep deprived state, the chances of abnormal activities in the brain being recorded are higher. EEG is performed under video recording to correlate the electrical activity with simultaneous abnormal body movements. Sometimes, prolonged EEG recording is also done for 48–72 hours to isolate the exact focus of abnormal activity.

  • Various electrodes are placed in frontal, parietal, temporal and occipital areas
  • Activities in these areas are recorded
  • Various manoeuvres such as photic stimulation, hyperventilation, eye opening and closure are performed during the recording
  • The responses are recorded to find any abnormality in the brain activity

  • Delta waves (0.5–4 Hz): during deep sleep and unconsciousness
  • Theta waves (4–8 Hz): during drowsiness and early sleep
  • Alpha waves (8–12 Hz): during relaxed state with eyes closed
  • Beta waves (13–30 Hz): during alert, thinking state

  • Epilepsy and seizures, status epilepticus
  • Sleep disorders
  • Coma, encephalopathy
  • Encephalitis and other brain infections
  • Metabolic disorders causing altered sensorium
  • Head injury
  • Additional testing for brain death
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Eosinophilic Lung Diseases

Management Team

Eosinophilic Lung Diseases

Overview

Eosinophilic lung diseases comprise a diverse group of conditions, including acute and chronic eosinophilic pneumonia, Löffler Syndrome, allergic bronchopulmonary aspergillosis, Hypereosinophilic Syndrome and eosinophilic granulomatosis with polyangiitis. These conditions are characterised by an abnormal accumulation of eosinophils in the lung tissues.

Eosinophils, white blood cells involved in immune responses, particularly in allergies and parasite defence, can cause inflammation, tissue damage, and respiratory symptoms when present in large amounts in the lungs. Some causes include:

  1. Infectious

    Parasitic infections, such as Ascariasis and Strongyloidiasis, are the most common cause of eosinophilic pneumonia (EP) worldwide.

  2. Non-infectious
    • Allergic bronchopulmonary aspergillosis (ABPA)
    • Medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, and selective serotonin reuptake inhibitors (SSRIs)
    • Inhaled toxins, such as chemical fumes, particulate metals, or dust
    • Smoking, especially if you've recently changed your smoking habits
    • Underlying conditions, such as cancer, autoimmune disease, or inflammatory disease

Common symptoms of eosinophilic lung diseases include persistent cough, dyspnoea (difficulty in breathing), chest pain, and wheezing. Patients may also experience non-specific symptoms, such as high fever, night sweats, weight loss, and fatigue. Extrapulmonary complications (i.e., complications involving organs other than the lung) can include gastrointestinal issues and peripheral neuropathy (a disease that damages the peripheral nervous system), necessitating a multi-systemic diagnostic approach with a high degree of clinical suspicion.

Diagnosis of eosinophilic lung diseases typically involves imaging-based techniques like chest X-rays or CT scans to identify infiltration of substances, such as pus, blood or protein, into the lung alongside blood tests revealing elevated eosinophil counts. Clinical history review, skin testing for Aspergillus sensitivity, and measuring serum IgE levels are also important. Complex cases may require bone marrow biopsy or lung tissue biopsy for confirmation, guiding tailored treatment and management strategies.

Eosinophilic lung disease treatment involves a comprehensive approach based on the specific condition and its severity.

  • Initially, high-dose corticosteroids are administered intravenously to rapidly reduce inflammation and improve respiratory function, transitioning to oral steroids as symptoms improve for ongoing control.
  • Long-term management often includes maintenance corticosteroid therapy to prevent relapses.

Antifungal medications like itraconazole manage fungal growth, while immunosuppressive drugs such as hydroxyurea or interferon-alpha, and targeted biologic therapies like monoclonal antibodies (e.g., mepolizumab) effectively reduce eosinophil levels and manage symptoms. Severe cases may require stronger immunosuppressive agents like cyclophosphamide or azathioprine.

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E

Cystic Fibrosis

Management Team

Cystic Fibrosis

Overview

Cystic fibrosis (CF) is a genetic (inherited) disorder that is characterised by the build-up of thick phlegm (mucus) and other fluids in different parts of the body, including the lungs and the digestive system (pancreas, liver and intestine). This mucus clogs the airways, making it difficult to breathe. Because of these issues, many people consider CF a lung disease, but it is called “cystic fibrosis” as it is also characterised by cysts and scarring in the pancreas.

CF is caused by a mutation (abnormality) in the CFTR gene. To inherit the disease, a person needs to inherit the mutated gene from both the parents. An individual’s parents do not have to have CF for them to have CF. Individuals with just one copy of the CFTR mutant are called carriers.

The thick mucus in the lungs causes people with CF to get frequent lung infections. Over time, these infections damage and destroy the lung architecture and functioning. The thick fluids in the pancreas and liver keep the intestine from absorbing certain nutrients from food. This affects a person’s growth and causes problems with bowel movements.

CF signs and symptoms vary, depending on the severity of the disease. Even in the same person, symptoms may worsen or improve as time passes. Some people may not exhibit symptoms until their teenage years or adulthood. People who are not diagnosed until adulthood usually have milder disease and are more likely to have atypical symptoms.

Common symptoms of CF include:

  • No weight gain
  • Long-lasting cough: The cough usually brings up mucus and sounds "wet." Some people cough up blood.
  • Trouble breathing or breathing that sounds like whistling (wheezing).
  • Frequent infections of the lungs or sinuses (i.e., pneumonia, bronchitis, sinusitis).
  • Salty skin, i.e., if your child has CF, you might taste salt when you kiss them.
  • Belly pain, diarrhoea, or constipation (trouble having bowel movements).
  • Loose, oily or bad-smelling stool.
  • Infertility.

Although CF is progressive and requires daily care, people with CF are usually able to attend school and go to work. Individuals with CF, in the present era, usually have a better quality of life than those in the previous decades.

The tests for CF include:

  • Newborn screening: This test is done soon after birth.
  • “Sweat test”: During this test, the doctor makes a person sweat and then measures the amount of salt in the sweat.
  • Blood tests to check for the abnormal gene.
  • Pulmonary function tests: These tests evaluate lung performance.
  • Sputum culture: Mucus coughed up by the lungs is tested for bacteria as certain bacteria, like Pseudomonas, are commonly found in people with CF.

  • Medicines called “CFTR modulators” help manage symptoms arising because of abnormal genes. Usually provided after genetic tests.
  • Antibiotics to help prevent or treat infections.
  • Bronchodilators are given through inhalers or nebulisers to open up the airways.
  • Chest physiotherapy: This includes exercises designed to help break and loosen the mucus in the lungs and make it easier for the patient to cough it out and clear the airways to reduce infections in the future.
  • Lung transplant: In cystic lung disease surgery, a surgeon replaces a person's diseased lungs with healthy lungs. A lung transplant is done only an individual has severe disease and meets certain conditions.
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C

Coronavirus Disease-19

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Coronavirus Disease-19

Overview

COVID-19 is caused by the novel coronavirus SARS-CoV-2 belonging to the coronavirus family, which also includes viruses responsible for common cold and more severe diseases like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The virus mainly targets the respiratory system, but its effects can be systemic, i.e., impacting multiple organs.

The infection spreads mainly when an infected person coughs, sneezes, or talks and spreads the respiratory droplets. Aerosol (liquid particles suspended in air) transmission is possible in poorly ventilated spaces. Further, indirect transmission can also occur through contaminated surfaces.

Patients usually present generalised symptoms, such as fever, chills, cough, fatigue, and loss of taste or smell; however, severe symptoms, such as difficulty in breathing and chest pain are also observed in some cases. Older adults or individuals who already have underlying medical conditions such as diabetes or high blood pressure are at greater risk of serious illness.

Individuals who do not present any symptoms but test positive for COVID-19 are termed asymptomatic. Individuals who go on to develop symptoms are considered presymptomatic. Both types of individuals are capable of spreading COVID-19 to others.

COVID-19 may be subdivided into mild, moderate, severe, or critical illness:

  • Mild COVID-19: The ability of lungs to transport oxygen to the body is not affected.
  • Moderate COVID-19: The lungs work properly but there are indications that the infection has deeply penetrated them.
  • Severe COVID-19: The lungs don't work correctly, and the affected individual needs oxygen and medical help.
  • Critical COVID-19: The lungs and the respiratory system have failed and the whole body has been affected as a result.

Get emergency help right away for any of these symptoms:

  • Inability to catch your breath or there are problems in breathing
  • Skin, lips or nail beds turn pale, grey or blue
  • Trouble staying awake or waking up
  • Constant chest pain
  • New confusion

Diagnostic tests include:

  • PCR test: the gold standard due to its high sensitivity in detecting viral RNA
  • Antigen test: offers faster results but are less accurate

Healthcare systems play a pivotal role through preparedness and developing protocols for handling such patients. This ensures effective communication and education to combat misinformation and promote health guidelines.

Treatment for COVID-19 varies based on the severity of the case. Mild cases often require self-isolation and symptomatic treatment. Moderate to severe cases may require isolation and treatment with antiviral medications like remdesivir, monoclonal antibodies for high-risk patients, anti-inflammatory drugs like dexamethasone for severe inflammation, and oxygen therapy for those with low blood oxygen levels. Critical cases might need mechanical ventilation.

Post-COVID/Long COVID:

Post-COVID care addresses long-term symptoms known as Long COVID, which can include fatigue, respiratory issues, and cognitive difficulties. This requires a multidisciplinary approach involving pulmonologist as centre point with good supportive care and dedicated physiotherapy department all under one roof, to provide the best possible care making a complete recovery seemingly possible.

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C

Chronic Obstructive Pulmonary Disease (COPD)

Management Team

Chronic Obstructive Pulmonary Disease (COPD)

Overview

COPD is a common lung disease that is associated with restricted airflow and breathing problems. Even though it is a well-known pulmonary disease, it also affects other organ systems leading to unintentional weight loss, skeletal muscle dysfunction, increased risk of cardiovascular disease, osteoporosis and depression.

COPD has two major phenotypes, emphysema and chronic bronchitis.

People with COPD are at a higher risk of developing other health issues, including:

  • lung infections (flu or pneumonia)
  • lung cancer
  • weak muscles and brittle bones
  • heart problems
  • depression and anxiety

COPD is mainly caused by long-term exposure to irritating gases or particulate matter (mix of solid and liquid in air, which includes dust, dirt, soot, and smoke; most often from cigarette smoke). Nowadays, air pollution is also a significant risk factor. Genetic factors, such as a deficiency of a protein called alpha-1 antitrypsin, are responsible for the development of COPD at a young age.

COPD-associated changes in lungs and airways include:

  • Loss of elasticity in the airways and air sacs of the lungs (alveoli)
  • Inflammation, scarring and narrowing of the airways
  • Thick mucus in the airways
  • Destruction of the walls between the alveoli, resulting in their enlargement and trapping of air

Common symptoms include breathing difficulty, cough, mucus (sputum) production, and wheezing. These symptoms often don't appear until significant lung damage has occurred, and they usually worsen over time.

COPD is typically diagnosed based on a combination of patient history, physical examinations, and lung function tests like spirometry, which measure the amount of air a person can exhale and the rapidity with which they can do so. CT Chest is also used for diagnosis.

Though COPD is not curable, its progression can be controlled with various treatments. These include lifestyle changes (like quitting smoking), medications (such as bronchodilators and inhaled steroids), pulmonary rehabilitation, vaccinations, and in severe cases, oxygen therapy, BiPAP (Bi-level Positive Airway Pressure), or surgery.

The most effective way to prevent COPD is to never start smoking or to quit smoking if you already do. Avoiding exposure to other lung irritants can also help reduce the risk of developing COPD. 

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C

Bronchiectasis

Management Team

Bronchiectasis

Overview

Bronchiectasis is a chronic lung condition characterised by the permanent dilation and damage of the bronchi, which are large to medium-sized airway passages leading to the lungs. This condition results from repeated infections and inflammation.

The causes of bronchiectasis are varied. It is usually a consequence of severe lung infections, such as tuberculosis, pneumonia, or whooping cough, or it can arise from conditions like cystic fibrosis, immunodeficiency disorders, and primary ciliary dyskinesia. Additionally, conditions like allergic bronchopulmonary aspergillosis and inhalation of toxic substances can also contribute to the development of bronchiectasis.

Patients with bronchiectasis experience persistent cough, often producing large amounts of sputum (mucus), and may suffer from recurrent respiratory infections, wheezing and shortness of breath. Fatigue and chest pain are also common, affecting the overall quality of life.

Diagnosis

High-resolution computed tomography (HRCT) of the chest, i.e., HRCT Chest is the gold standard for diagnosis. Other investigations are done to know the cause of bronchiectasis; these include but are not limited to sputum examination, nasal nitric oxide level analysis, sweat chloride test, immunoglobulin level analysis and Aspergillus-specific immunoglobulin analysis.

Treatment

Only a specialist can identify the underlying cause of bronchiectasis for its effective management. Treatment is focused on managing the symptoms and preventing complications. This requires a multidisciplinary approach that includes airway clearance techniques, such as chest physiotherapy and postural drainage, medications like antibiotics to treat infections, bronchodilators, and sometimes surgical intervention.

Pulmonary rehabilitation also plays a significant role in maintaining lung function.

Regular follow-ups with healthcare providers are essential to monitor the condition and adjust treatment plans as needed for maintaining lung health.

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B

Asthma

Management Team

Asthma

Overview

Asthma (also known as bronchial asthma) is a chronic respiratory condition which affects both children and adults, and is the most common chronic disease among children.

Asthma triggers. Author credits: 7mike5000 on Wikimedia Commons

Asthma has multiple causes, and based on the causes, it can broadly be divided into two categories:

  • Allergic: Allergens (e.g., moulds, pollen, pet dander, dust mites) and irritants (e.g., smoke, strong odour, cold air) are responsible for the asthma attack.
  • Non-allergic: Outside factors, such as exercise, stress, illness and weather cause an asthma flare-up.

Importantly, asthma can also be genetic.

Three things can happen during an asthma flare-up (also known as an asthma attack or exacerbation):

  • Bronchospasm- The muscles around the airways tighten, making them narrow. This results in difficulty in air flow through the airways.
  • Inflammation- The lining of the airways swells up, and swollen airways make air flow (to and from the lungs) difficult.
  • Mucus production- During an asthma flare-up, the body creates more mucus, which clogs the airways.

All these result in the production of a wheezing sound when one tries to breathe.

The diagnosis of asthma is based on a combination of symptoms, physical examination findings and lung function tests (especially spirometry). The culprit allergens are identified using an allergy test.

Asthma care focuses on controlling symptoms and preventing exacerbations, which involves: 

  • Trigger Avoidance: Identifying and avoiding triggers that worsen asthma symptoms, such as allergens or irritants.
  • Medications: Inhalers are the mainstay of asthma treatment, including quick-relief medications (short-acting beta-agonists) to relieve acute symptoms and long-term medications (inhaled corticosteroids, long-acting beta-agonists) to reduce inflammation and prevent symptoms. 

Biologic therapies: If routine medicines are ineffective, an add-on controller therapy called biologics might be an option for some patients with severe asthma. Biologics work by disrupting cells or blocking specific molecules that trigger inflammation. 

  • Monitoring: Regular monitoring of lung function is essential using peak flow metres or spirometry to assess asthma control. 
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A

Allergy

Management Team

Allergy

Overview

Allergy is the excessive response of our immune system to otherwise harmless substances in the environment. These substances, known as allergens, trigger an immune reaction that can lead to various symptoms and affect different organs in the body.

The prevalence of allergic disorders is increasing worldwide. Risk factors include:

  • Genetics (a family history of asthma or allergies)
  • Age (children are more susceptible to developing allergies)
  • Environmental changes
  • Hygiene hypothesis

Common allergic triggers may be through food, insects, latex, pollen, pets, drugs, mold, or gluten.

  • Allergic Rhinitis: Often known as hay fever, atopic rhinitis is characterised by sneezing, itching, nasal congestion, and watery eyes. This condition can be triggered by pollen, dust mites, pet dander or mould.
  • Asthma: Asthma is a chronic respiratory condition characterised by inflammation and narrowing of the airways, leading to breathing difficulties, wheezing, and coughing. In addition to allergens, respiratory infections as well as exercise can also trigger asthma attacks.
  • Atopic Dermatitis: Also known as eczema, atopic dermatitis is characterised by itchy and inflamed skin. It often develops during early childhood and its intensity can be increased by allergens like pet dander, irritants, or certain foods.
  • Food Allergy: Food allergies occur when the immune system reacts to specific proteins present in certain foods, triggering symptoms that can range from mild itching to severe anaphylaxis.
  • Anaphylaxis: Severe allergic reaction is called anaphylaxis and it can be life-threatening. Typically, it occurs rapidly after exposure to an allergen. Symptoms include difficulty in breathing, swelling of the throat, rapid pulse, and a drop in blood pressure.

Diagnosis involves the steps that your healthcare professional takes to find out whether you have an allergy. Your healthcare professional will likely:

  • Ask detailed questions about your symptoms.
  • Do a physical exam.

If you have a food allergy, your healthcare professional will likely:

  • Ask you to keep a detailed diary of the foods you eat.
  • Ask if you've stopped eating the suspected food during the allergy exam.

Your healthcare professional also may recommend one or both of the following tests.

  • Skin test: A healthcare professional uses a tiny needle to prick or scratch your skin and expose you to small amounts of the proteins found in your potential allergens. If you're allergic, you'll likely develop a raised bump called a hive at the test area on your skin. 
  • Blood test: This test measures the amount of antibodies that the blood makes to destroy allergens. Your blood sample is sent to a lab to find out if you're sensitive to suspected allergens.

Allergic disorders are managed by identifying the culprit allergens using an allergy test, avoiding known and potential triggers where possible. Anaphylaxis management involves cardiopulmonary resuscitation (CPR; if the patient stops breathing) and medications, such as adrenaline (to reduce the allergic response), oxygen and intravenous (IV) antihistamines and beta-agonists. Immunotherapy for allergies (allergy shots) may also be recommended to desensitise the individuals to specific allergens.

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