Maharaja Agrasain Super Speciality Chest Center

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Hi everyone!

I am Dr. Hemant Kalra, I am a pulmonologist. Today I will talk about a very important topic, Interstitial Lung Disease. Before I tell you what this disorder, I must tell you something about interstitium. What is interstitium? Instertitium is a tissue in the lungs through which air from the lungs, small air sacks called alveoli passes to enter into the lungs small blood vessels called capillaries. So in Interstitial Lung disease, this instertitium is affected. So what happens in Interstitial Lung disease, in this disorder, there is reduction of the ability of the lungs to deliver oxygen to the blood vessels. Secondly, this disorder distorts the normal lungs structure. Lungs become smaller and stiffer. Interstitial Lung disease affects both men and women. It is very rarely communicable but it is not at all contagious. In some ILDs there are no clatters, but most of them are idiopathic in nature, idiopathic means there are no root causes. So what are the symptoms?

Symptoms are mostly exertion recklessness may or may not be associated with cough or cough is predominantly dry in ILDs. Sometimes, joints, skins and eyes are also affected. Only then it is associated with connective tissue disorders. So how do we classify Interstitial Lung Disease. We can classify ILD in many ways. But in a simple manner, we can classify into three types. First when ILD is only limited to the lungs. It is called idiopathic pulmonary fibrosis. Secondly when it is primarily associated with other parts of the body like in scleroderma, rheumatoid arthritis and sarcoptosis. Thirdly when ILD is associated with known triggers. First is hypersensitivity pneumonitis, second is medications which is associated with ILDS, third is Sarcoidosis, Asbestosis.

So these are the three predominant types of ILDs. So how do we diagnose Interstitial Lung Disease. First of all we have to suspect Interstitial Lung Disease in all patients with exertion, with breathlessness. Further, we can ask for chest x-ray, pulmonary function test, certain blood tests are also advised sometimes, but predominantly high-resolution ct scanning with diagnostic modality. Further, we can go for bronchoscopic biopsy, lung biopsy can also be advised but most of the time chemical suspension, illegal symptoms and high-resolution ct scan can give you the diagnosis of Interstitial Lung Disease. So what is the treatment of Interstitial Lung Disease? Treatment is first of all lifestyle changes like smoking cessation, weight reduction, exercising regularly as in all chronic respiratory disorders. Second is we must avoid drinkers like in Hypersensitivity pneumonitis, Asbestosis, and Sarcoidosis.

So treatment depends on the type of ILD and severity of ILD. Treatment of ILDshould be given by pulmonologist who is specialized in intestinal lung diseases management. There are many drugs in the market for treatment of Interstitial Lung Disease. Most of the times steroids are integrated like in connective tissue disorders, in Sarcoidosis and certain ILDs like NSIP (Nonspecific interstitial pneumonitis). Steroid works very well in such condition but in certain idiopathic conditions, there are two drugs in the market. Both the drugs are available in India. Normally we give those drugs to a patient of idiopathic pulmonary fibrosis. So the treatment is very very limited. The basic thing is we have to diagnose Interstitial Lung Disease as early as possible. Start treatment as early as possible and should be initiated by a pulmonologist only. So in the natural Interstitial Lung Disease the chronic respiratory disorder should be diagnosed as early as possible so that respective treatment can be initiated very early in the disease process. So kindly refer all your patients to specialized centers or pulmonologist who are specialized in dealing such cases so that further lung injury can be prevented.

Thank you very much!

Good afternoon!

I am Dr. Hemant Kalra. I am a pulmonologist. Today our talk will be about inhalation therapy in respiratory disorders. So what is inhalation? Inhalation is when we give drugs or solution of drugs by nasal or oral respiratory route. Inhalation is also called inspiration. What is the inspiration? Inspiration is movement of air from external environment by our breathing pipes into our lungs. This is inhalation and inspiration also. In which conditions we use inhalation therapy? Inhalation therapy is used in Obstructive Airway Disorders. What are these disorders? These are Asthma, COPD, Bronchitis and some cases of Sarcoidosis. You may ask me why tablets and syrups are not used in such disorders?

Why inhalation therapy is preferred over tablets and syrup in such disorders because- tablets and syrup are in high doses, they are very toxic, very costly, they reach systemic blood circulation, they have got adverse side effects. When you give a drug, tablet or syrup it first enters your stomach, then via your blood stream it enters your airways where inflammation is there and where these types of drugs are required. So why to give a drug in oral or syrup form when inhalation therapies are available. Inhalation therapies takes drugs directly where it is required. Inhalation therapy can be given in various forms. First is metered dose inhaler. You might have seen inhaler people using in movies.

Dry powder inhalers are also available in market and other forms like nebulation is also available. What drugs can be given in inhalation therapies? We can give bronchodilators, which can open up the airways. We can give Cortico-steroids. Mucolytics and some antibiotics can also be given via inhalation route. Nowadays insulin is also given in inhalation route. Inhalation therapy is very very effective in certain disorders. I started this topic because I felt that we in India do not use inhalation therapy because of various myths in our society. So what are the myths? Firstly, inhalers are very costly- absolutely wrong. Secondly, inhalers are addictive- absolutely wrong. Thirdly, inhalers have got side effects- also absolutely wrong. Inhalers do not have any side effects. I can assure you this that inhalers can be given in pregnancy from day 1 to 9th month when very few drugs are recommended in pregnancy.

It can be given in any age group from 1 year to 90 years. Fifthly, inhalers are always given when disease is very severe- it is also wrong. On the contrary inhalers are recommended or should be given as early as possible in the disease. So inhalation therapy is the best option for any kind of obstructive airway disorders. I can proudly say that we have got the best inhalation technique or inhalers available in India. You must use them as advised by the doctor. Do not say no when the doctor writes an inhaler for you. It is the best option for obstructive airway disorders because it is most effective with no side effects, very cheap and can be given for many years. Thank you very much! In the nutshell please use inhalers as adviced by a doctors. Do not hesitate to take inhalers. Inhalers are best option for obstructive airway disorders, very safe, very effective, no side effect and very cheap.

Thank you very much!

Good afternoon friends,

I am Dr Hemant Kalra, I am a pulmonologist.

Today I will talk about a very-very important topic that is Obstructive Sleep Apnea which is widely prevalent in our country but very-very underdiagnose and awareness is very-very less. So what is obstructive sleep apnea, those patients who snore very-very heavily, who feel tired or feel sleepy during the daytime they may have Obstructive Sleep Apnea. So what is normal breathing, normal breathing is when our upper airways they allow free air to go inside the lungs and out of the lungs, this is normal breathing. So what are the obstructive airways, obstructive airways is then these upper airways collapse and this collapse of upper airways causes snoring and sensation in breathing, this is abnormal breathing or obstructive breathing at night time when we sleep? So what are the symptoms, symptoms can be nighttime symptoms can be there or daytime symptoms can be there. Night time symptoms are frequent visits to bathroom, weakness, sensation in breathing, choking or gasping for air or loud a persistent snoring or restless sleep, these 5 can be there in the night time symptoms and daytime symptoms are early morning headache, lethargy, and poor concentration, poor memory, feeling asleep during and routine activities and daytime somnolence or daytime sleepiness, these are daytime symptoms. So what kinds of patients are prone to have obstructive sleep apnea. Those patients who are obese with a short and thick neck with large tongue or hypothyroidism such patients if they snore heavily or feel tired or sleepy during the daytime or if they have night time or daytime and symptoms they must be investigated for obstructive sleep apnea. So how to diagnose obstructive sleep apnea, there is a very small test called polysomnography that can be done at a house or in hospitals. That is conducted in two parts, one is diagnostic, one is titration in diagnostic. We diagnose, whether a patient is having obstructive episodes in the night or not, or in another part, if an obstruction is there what is the pressure required to eliminate those obstructions in the night time. So obstructive diagnostic and titration component one night sleep steady is more than enough. Once we diagnose obstructive sleep apnea then we have to treat it also. There are so many treatments available but gold standard till now is CPAP therapy Continuous Positive Airway Pressure therapy is the most appropriate therapy to treat obstructive sleep apnea and once you treated you will feel that next day if you get up you will feel very-very energetic and if you do not treat obstructive sleep apnea then you may have heart problems, rythm problems, your BP may not be controlled, your sugar may not be control, you may have strokes in future also. So, if you treat obstructive sleep apnea with CPAP therapy, it is a gold standard therapy in India it is widely available in our country but lack of awareness is there. It is a very important disorder you must be treated as early as possible.

Thank you.

Hello friends, I am Dr Hemant Kadra. I am a pulmonologist. A pulmonologist is a doctor who deals with respiratory problems. Today I will be explaining Asthma in a very simple manner because it is a simple disease.
So, when to suspect asthma?

All patients who are present with a cough with or without breathlessness on exposure to dust, fumes, cold atmosphere, on eating chilled vegetables and fruits can have asthma. They also give family histories of allergic disorders like allergic dermatitis, allergic rhinitis so we can suspect asthma in our patients who are present with a cough with or without breathlessness and on exposure to such triggers like cold, dust, fumes, change of weather- this is the clinical history.
There are 2 components-

One is prevention. You must avoid all your triggers. And treatment part is slightly different. Treatment is we have to control swelling in the area, narrowing of the airways.

There are 2 kinds of medication- one is a reliever and the other is preventer medication. Reliever medication gives you immediate relief and preventer medication is given for a longer amount of time just to maintain the anti-inflammatory component in the airways. So, we combine both the type of medications in an inhaler or one rhotahaler to give maximum benefits to the patients. So, these are the basic things about asthma.

I will tell you about basic myths about asthma. What people think about asthma but is not true. People think that asthma is a contagious disease. It is communicable. No, it is not true.

• It is an allergic disorder first of all. Asthma or allergy runs in families because it is a genetic disorder.
• Secondly, an inhaler is a drug delivery system. It is not a drug. It delivers lowest possible drugs to the airways to a very minimum side-effect. So, this myth is not true that inhalers are very hard, they are addicting, habit forming, it is not true. It is a drug delivery system.​
• Third myth is that inhalers are to given to severely ill patients or very chronic asthmatic patients this is also not true. We believe that inhalers should be given early whenever they are detected with asthma early in the disease. So, to prevent later chronic changes in the airbase, we should start inhalers in the beginning only.

So, if you want to consult me, you can cotact me through Lybrate. You can contact me through sms, sudio clips, video clips, whatsapp, email only through lybrate. Com. I am available 24 hours a day and ready to help you.

Thank you.