Pulmonology

Asbestosis is a lung disease that causes shortness of breath and chest pain. It usually occurs when one inhales asbestos fibres. The symptoms of asbestosis can be mild and severe. However, this only happens after inhaling asbestos for several years. Researchers are yet to find a cure for asbestosis, but specific measures and medications can slow its progression and milden its symptoms.

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At Max Hospital, we understand that asthma could be a major concern for affected individuals, which may impact their physical well-being and overall quality of life. Committed to addressing this challenging condition, our pulmonology team, led by some of the best pulmonologists in India, is ideally equipped to offer personalised treatment and management plans for asthma. We employ cutting-edge technology and evidence-based medical approaches to tailor individualised asthma therapy plans to help alleviate symptoms and proactively manage and prevent future exacerbations, empowering patients to resume daily activities, while promoting their respiratory health and overall well-being.

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Bronchiectasis is a chronic disease that worsens over time. It occurs when the walls of the bronchi become permanently damaged, widened, and thickened. The damaged air passages allow bacteria and mucus to thrive and pool in the lungs resulting in infections and blockages of the airways frequently. This makes it difficult for the person to breathe. There's no cure for bronchiectasis, but it can be managed. With treatment, a person can typically live a normal life. Patients could have flare-ups of severe breathing problems from time to time. However, they must be treated quickly to maintain adequate oxygen flow to the rest of the body and prevent further lung damage.

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Bronchitis is an inflammatory condition affecting the bronchial tube lining, which transports air to and from the lungs. The trachea and bronchi airways become inflamed and clogged with mucus. As the body tries to remove the mucus, a persistent cough develops. Bronchitis patients frequently cough up thick mucus that might be coloured. It can be acute or chronic. Acute bronchitis is a common condition that frequently results from a cold or other respiratory illness. Chronic bronchitis, a more severe condition, is characterised by persistent irritation or inflammation of the bronchial tube lining, which is often caused by smoking.

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Bronchoscopy is a medical examination that allows the doctor to examine the airways in the body. In the test, the doctor threads an instrument called a bronchoscope through the nose or mouth and further down the throat to reach the lungs. The bronchoscope is made of a flexible fibre-optic material, which has a light source as well as a camera at its end. Most bronchoscopes are well-matched with colour video, which helps the doctor document their findings.

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Chronic obstructive pulmonary disease is one of the most common lung diseases today. It makes it difficult for the person to breathe. There are two major forms of COPD: Chronic bronchitis, which involves a long-term cough with mucus Emphysema, which involves destruction of the lungs over time. There are two major forms of COPD: Chronic bronchitis, which involves a long-term cough with mucus Emphysema, which involves destruction of the lungs over time

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COPD (Chronic Obstructive Pulmonary Disease) is a chronic lung disease characterized by a progressive limitation of airflow. It is primarily caused by long-term exposure to cigarette smoke, air pollution, chemical fumes, or other irritants. The disease typically starts with mild symptoms, such as coughing and shortness of breath, and worsens over time if not properly managed.

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Dust mites are eight-legged microscopic organisms resembling spiders and ticks. They flourish in warm, moist habitats. In most homes, various items like bedding, carpeting, and upholstered furniture provide an ideal environment for dust mites. These feed on the flakes of skin that people and pets shed daily. They are considered to be the most common trigger of allergies and asthma. Dust mites also have cross-reactivity with other allergens, leading to various food allergies as well.

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Dyspnea, also known as shortness of breath, is the feeling of uneasiness when one can't breathe enough air into their lungs. The chest has a tight feeling, and the person cannot breathe deeply. It can be linked to many other health conditions like asthma, lung disease, heart failure, and problems such as anxiety and allergies. However, one can also experience temporary breathlessness after an intense workout or other physical activity.

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Emphysema is a chronic lung disease that progressively damages the air sacs in the lungs, making it increasingly difficult to breathe. Over time, simple activities like walking or climbing stairs can become exhausting, as the lungs struggle to take in enough oxygen. This constant shortness of breath can significantly impact both physical health and daily life. At Max Hospital, one of the top emphysema hospitals in India, we understand the significant challenges that come with living with emphysema. Our team of pulmonologists, respiratory therapists, and thoracic surgeons work together, using the hospital’s modern-day technologies and equipment, to help patients manage their symptoms and improve their quality of life.

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Fungal sinusitis, also known as fungal rhinosinusitis, is an infection of the sinus caused by a fungus. Most fungal sinus infections have similar symptoms, including nasal congestion and sinus pain - pain between the eyes, the forehead, and cheeks. Fungal sinusitis is usually treated with surgery and sometimes requires additional anti-fungal treatment. However, people with healthy immune systems may not require any treatment. In addition, some fungal sinus infections may clear on their own. People with a weak defence system are more likely to suffer fungal sinusitis, often carrying a higher risk of developing complications. Some types of fungal sinusitis destroy the lining of the nose, may spread to the brain, and cause death.

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Lung nodules are small, sometimes pre-cancerous, benign growths in the lung. However, some nodules (about 5%) may turn malignant, proliferate rapidly, and spread to other body parts. They are commonly found in adults and appear as a shadow on the X-ray. However, on a CT scan, it appears as a white spot. They are caused by scar tissue, some air irritants, or a healed or pre-existing infection. The nodule may be solitary or multiple and affect one or both lungs.

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Pneumothorax, also termed as deflated lung or collapsed lung, is a condition that occurs when there is the presence of air in the pleural space, i.e. the distance between the chest wall and the lungs. As a result, air tends to push on the outer surface of the lung, making it unable to expand causing it to collapse either partially or entirely. It needs immediate medical attention as it can be fatal and life-threatening. Types of Pneumothorax There are a few different types of pneumothorax, depending on their cause and impact. These are as follows: Traumatic pneumothorax Non-traumatic pneumothorax Other subtypes with either traumatic or non-traumatic causes are: Simple Tension Open Traumatic Pneumothorax: It occurs as a result of some trauma or injury to the chest wall or lung. The trauma can damage chest structures, and the air gets deposited into the pleural space. Immediate management is required for this type as it can lead to cardiac arrest or even respiratory failure. Following is the list of injuries responsible for causing traumatic pneumothorax: Broken ribs. Stab wound to the chest cavity. Involvement of an individual in a road traffic accident Bullet injury to the chest. Being at high altitudes . Accidental damage in a person because of lung biopsy or CPR. Non-traumatic Pneumothorax: This type of pneumothorax is often spontaneous because it does not result from trauma. Therefore, it is either primary or secondary.  Primary spontaneous pneumothorax takes place mainly: During pregnancy Family history Smokers  Marfan Syndrome Individuals with a tall and thin body Secondary spontaneous pneumothorax can take place if a person has the following: Lung cancer Asthma COPD, including emphysema and chronic bronchitis Cystic fibrosis Pulmonary fibrosis Collagen vascular disease Severe acute respiratory distress syndrome Infections like tuberculosis or pneumonia Simple Pneumothorax: It does not involve the position of other structures. Tension Pneumothorax: It affects the position of other associated structures, like the heart and occurs due to some penetrating injury, rib fracture or blows to the chest. Open Pneumothorax: It occurs when there is a moment of air in and out of an open wound in the chest area. Symptoms of Pneumothorax Following are the symptoms of pneumothorax: Shortness of breath Unilateral chest pain during inspiration Cough Fatigue Tachycardia Dyspnoea Cyanosis Low blood pressure Anxiety Diagnosis of Pneumothorax In most cases, people with pneumothorax require immediate medical attention and care. First, the doctor will do the chest auscultation and look for related symptoms, family medical history and any previous history of pneumothorax. Apart from this, various other imaging tests are also performed, which are as follows: X-ray scans to access the outline of the lung. A CT scan comprises a series of X-rays to achieve a detailed lung image. Arterial blood gas (ABG) or pulse oximetry measures how much oxygen is in the blood. EKG to monitor the functioning of the heart. Treatment of Pneumothorax The main aim of treating pneumothorax is based on the re-expansion of the lungs. Treatment options usually depend upon the cause and severity of the problem. Following are the various treatment options available: Observation: For minor pneumothorax, the doctor may watch for the functioning of the heart or breathing issues. A follow-up visit accompanies this. Supplemental oxygen: The doctor provides extra oxygen if patients present with symptoms and make sure that the patient's condition remains stable. Needle aspiration: During aspiration, the doctor uses a syringe to clear some of the air in the pleural space and follows needle aspiration with percutaneous chest tube drainage. Chest tube drainage: If the patients have a more significant pneumothorax, the doctor may put a hollow tube in the chest area to reduce the air in the pleural space. As soon as the air pressure decreases, the lung re-expands and heals. Patients may have this tube in place for several days or even longer. Chemical pleurodesis: To prevent the lung from collapsing, the doctor may perform pleurodesis, which involves inserting a mildly irritant drug into the pleural space on one side of the chest. The chemicals used are doxycycline, which attaches the lung to the chest cavity, thereby eliminating extra room in the chest cavity. Surgery: A person is considered to be a candidate for surgery if:  Persistent air leakage from chest tubes. Traumatic lung injuries.  A lung that does not expand despite chest tube insertion Recurrent collapsed lung. Pneumothorax in both lungs. The patient doesn't respond to any other treatment. Video-assisted thoracoscopic surgery (VATS) is a minimally invasive procedure that uses a small camera to help the surgeon examine the lung and remove the lung tissue accordingly.  Lobectomy is a surgical procedure performed to remove one of the lobes of the lung. Risk Factors of Pneumothorax Risk factors for a traumatic pneumothorax include: Ongoing assisted respiratory care. Falls or other types of injury. Contact sports, like football or hockey. A medical procedure involving the chest or lung area. The people at highest risk of a non-traumatic pneumothorax comprises: Family history. Inflammation of small airways. History of smoking. Asthma or COPD The patient is on mechanical ventilation Complications of Pneumothorax These may include: Pneumohemothorax is a condition where blood enters the chest cavity. Respiratory failure. Bronchopulmonary fistula. Heart attack Pulmonary oedema Pneumopericardium is a condition where air enters the cardiac cavity. Pneumoperitoneum is a condition where air enters the abdomen. Prevention of Pneumothorax Avoid smoking. Avoid activities associated with enormous pressure changes. Regular follow-up to rule out any lung conditions. Outlook of Pneumothorax The long-term outlook for patients with pneumothorax depends on the size and cause of pneumothorax and the treatment received. The majority of the cases are resolved with observation and minimal healing. It takes longer to heal if there are: Underlying lung condition. Large pneumothorax. Secondary spontaneous pneumothorax. Injury related pneumothorax. Review Reviewed by Dr. Inder Mohan Chugh - Senior Director, Pulmonology.

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Pulmonary Edema refers to fluid retention in lungs and is often caused by congestive heart failure. In this condition, the heart is not able to pump blood to the body efficiently; it can back up into the veins that take blood through the lungs to the left side of the heart. Congestive heart failure that leads to pulmonary edema may be caused by: Heart attack, or any disease of the heart that weakens or stiffens the heart muscle (cardiomyopathy) Leaking or narrowed heart valves (mitral or aortic valves) Sudden, severe high blood pressure (hypertension) Congestive heart failure that leads to pulmonary edema may be caused by: Heart attack, or any disease of the heart that weakens or stiffens the heart muscle (cardiomyopathy) Leaking or narrowed heart valves (mitral or aortic valves) Sudden, severe high blood pressure (hypertension)

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A pulmonary embolism occurs when one of the pulmonary arteries in the lungs gets blocked. Often, pulmonary embolisms are caused by blood clots that enter the lungs via deep leg veins or, in some cases, from veins in other areas of the body. It can be fatal because the blood clots prevent blood circulation to the lungs. However, early diagnosis and treatment reduce the risk. The risk of developing pulmonary embolism can be reduced by taking steps to avoid blood clots in the legs. Symptoms of Pulmonary Embolism The symptoms of pulmonary embolism differ depending on the size of a blood clot and if a person has underlying heart or lung disease. Common symptoms of pulmonary embolism include: Cough  Chest pain Shortness of breath and uneasiness Irregular heartbeat Excessive sweating Fever Dizziness and lightheadedness Swelling or pain in the legs  Hemoptysis (coughing out blood) Causes of Pulmonary Embolism Pulmonary embolism is commonly caused when a blood clot blocks an artery in the lung. In most cases, these blood clots form in the deep veins of a person’s leg and move to the arteries. This condition is called deep vein thrombosis.  Pulmonary embolism frequently involves many clots. Each clogged artery drains blood from the regions of the lung it supplies, which might be life-threatening. This is referred to as a pulmonary infarction. This makes it harder for the lungs to supply oxygen to the rest of the body. Apart from blood clots, other substances can also obstruct blood arteries, including: Air bubbles Fat from a shattered long bone’s marrow Tumor fragment Diagnosis of Pulmonary Embolism Diagnosis of pulmonary embolism can be difficult, especially for those with underlying heart or lung illness. Because of this, the doctor will probably inquire about a patient’s health history, conduct a physical examination, and request one or more of the following tests: Blood test: A blood test for the clot-dissolving chemical D dimer substance may be recommended. While many other factors can also cause high D dimer levels, high levels may signify an increased risk of blood clots. Blood testing may also be used to identify any hereditary clotting disorders a person may have. Levels of oxygen and carbon dioxide can also be determined by blood tests. The amount of oxygen in the bloodstream may decrease if there is a clot in a blood artery in the lungs. Ultrasound: Duplex ultrasonography, also known as duplex scan or compression ultrasonography, is a non-invasive procedure that uses sound waves to scan the veins in the thigh, knee, calf, and sometimes the arms to check for deep vein blood clots. The transducer, a wand-like tool that directs sound waves to the veins being tested, is moved over the skin. To generate a moving image on a computer, these waves are then reflected back to the transducer. The risk of deep vein thrombosis is lower when there are no clots. If clots are found, treatment will most likely begin right away. CT Pulmonary Angiography (CT - PA) with deep venous thrombosis (DVT) Protocol: The most common and most reliable test done in susceptible cases of pulmonary embolism & lower limbs. Pulmonary angiography: This procedure gives a precise image of the blood flow in the lungs’ arteries. It is the most accurate diagnostic procedure, but it has significant risks and is only used when other tests are unsatisfactory. In pulmonary angiography, a flexible tube (catheter) is inserted into a major vein, often in the groin, through the heart and into the pulmonary arteries. The catheter is then filled with a particular dye, and X-rays are obtained while the dye travels down the arteries in the lungs. Chest X-ray: This non-invasive scan is recommended to rule out illnesses that mirror the disease even though they cannot detect pulmonary embolism. Pulmonary Embolism Treatment The aim of pulmonary embolism treatment is to stop the blood clot from becoming larger and from re-forming. Immediate treatment is necessary to avoid major consequences or complications. Blood thinners: These medications help the body break up clots while preventing new clots from developing and existing clots from growing. Heparin is a common anticoagulant that may be administered through a vein or injected beneath the skin. It activates immediately and is frequently used for a number of days with an oral anticoagulant. Clot dissolvers or thrombolytics: Although clots often dissolve on their own, thrombolytics is administered to dissolve clots fast. These clot-busting medications are often only used in life-threatening situations due to the risk of abrupt and severe bleeding. Modern oral anticoagulants act more rapidly and cause fewer drug side effects. However, bleeding is the most frequent adverse effect of anticoagulants. Noval oral anticoagulants (NoAC) and other drugs Clot removal surgery: The doctor can advise clot removal surgery to remove a big, potentially fatal clot from the lung. The treatment uses a narrow, flexible tube (catheter) inserted through the blood vessels to remove clot. Complications of Pulmonary Embolism An embolism in the lungs may be fatal. Undiagnosed and untreated pulmonary embolisms can cause about one-third of patients to die. But when the problem is identified and properly treated, that number reduces. In addition to pulmonary embolism, pulmonary hypertension, characterised by excessively high blood pressure in the right side of the heart and the lungs, can result from pulmonary embolism.  When the arteries in the lungs are blocked, the heart is forced to work harder to pump the blood through it, raising blood pressure and eventually weakening the heart. In a few cases, small emboli commonly occur and grow over time, leading to chronic pulmonary hypertension (also known as chronic thromboembolic pulmonary hypertension). Risk factors of Pulmonary Embolism Heart condition: Clot development is more common in patients with cardiovascular illness, especially heart failure. Cancer: Chemotherapy can significantly raise the risk of blood clots in patients with certain malignancies, especially those that have spread to the brain, ovary, pancreas, colon, stomach, lung, and kidney. Women who have a personal or family history of breast cancer and take tamoxifen or raloxifene are also more likely to develop blood clots. Clotting-related disorders:  Some genetic blood abnormalities cause it to clot more easily. The risk of blood clots may also be increased by other medical conditions, such as renal illness. Smoking: Most people are prone to develop blood clots for unknown reasons, especially when tobacco use is combined with other risk factors. Overweight: Excess weight increases the risk of blood clots, especially in those with additional risk factors. Pregnancy:  Blood flow from the legs may be slowed by the weight of the baby pressing against pelvic veins. Blood that slows or accumulates is more prone to clotting. COVID-19: Those who have COVID-19 with significant symptoms are more likely to get pulmonary embolism. Surgery: One of the main causes of blood clots is surgery. For this reason, clot-preventing medicine may be used both before and after major surgery, such as joint replacement. Prevention of Pulmonary Embolism Pulmonary embolism can be avoided by preventing deep vein thrombosis (DVT) in the legs. To  avoid blood clots, doctors generally take proactive measures, such as: Blood thinners or anticoagulants: These drugs are frequently administered to patients at risk for blood clots before and after surgery, as well as to patients with diseases including heart attack, stroke, or cancer-related problems. Compression stockings: The veins and leg muscles are able to transport blood more effectively due to the constant compression provided by compression stockings. They provide a secure, easy, and affordable means of preventing blood stagnation during and after general surgery. Leg elevation: Elevate the legs with books or blocks during sleep, if possible. It could be really helpful. Raise the bed’s foot by 4 to 6 inches (10 to 15 cm). Exercise: Getting moving around as soon as possible after surgery will help prevent pulmonary emboli and speed up recovery. This is one of the main reasons why a patient is advised to get up and walk around the day of the procedure, even though patients might be in pain where the incision is. Pneumatic compression: This method uses thigh-high or calf-high bands that are frequently compressed and massaged with air that is regularly pumped in and out of the bands to improve blood flow. Avoid long sitting/sitting in one posture; for example, avoid long driving, travelling in aircraft, long office hours, etc. Review Reviewed by Dr. Inder Mohan Chugh - Senior Director, Pulmonology.

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Affecting the mood, weight, hormone levels and ability to sleep well, either because of stress or a continuing health problem, sleep disorders are becoming increasingly common owing to the fast-paced lifestyle.

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Tuberculosis (TB) is a harmful infectious disease that mainly targets the lungs and is characterised by the development of granulomas. The bacteria responsible for tuberculosis can spread from person to person through tiny droplets released into the air via coughs and sneezes. TB is a contagious infection that can predominantly involve the lungs but can involve most parts of the body, including the lymph nodes, gastrointestinal system, genitourinary system, brain, spine etc. A type of bacteria termed Mycobacterium tuberculosis causes it.

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