Obstructive Sleep Apnoea - Specialist Advice

What is Bronchiectasis?

Bronchiectasis is a chronic condition where the airways (bronchi) of your lungs are inflamed, infected, and permanently damaged.

Why Does Bronchiectasis Happen and How Does it Affect You?

If your lungs are injured, there will be inflammation and/or infection present in your bronchi. This leads to the accumulation of mucus and thickening of the walls of your bronchi. The condition finally results in a cycle of bacterial infection, a pool of mucus in your lungs, blockages in your bronchi, and gradual decline in your lung function over time. In the end, you will have difficulty with breathing.

What are the Risk Factors and Causes of Bronchiectasis?

Any sort of lung injury can lead to bronchiectasis and it can sometimes affect your whole body. You may also develop bronchiectasis if you have any of the following conditions:

A whooping cough and tuberculosis (forms of lung infections)
Humoral immunodeficiency (blood with low levels of infection-fighting proteins or abnormally functioning immune system)
Inflammatory bowel disease (Crohn’s disease and ulcerative colitis)
Rheumatologic diseases (rheumatoid arthritis and Sjögren’s disease)
Alpha1-antitrypsin deficiency (COPD caused by a genetic factor)
Chronic obstructive pulmonary disease or COPD
Infection with HIV or autoimmune diseases
Allergic bronchopulmonary aspergillosis (an allergic lung inflammation)

Bronchiectasis not only affects your lungs, but it may also have an impact on your pancreas and liver resulting in repeated infections and poor functioning of these organs.

Symptoms of Bronchiectasis

Symptoms of typical bronchiectasis may take several months or even years to develop and manifest. Therefore, you should see your doctor for diagnosis and treatment if you:

Experience frequent respiratory infections
Have a chronic cough and discharge of blood or mucus mixed with blood
Are coughing up a large amount of thick yellow or green mucus regularly
Produce abnormal or wheezing or whistling sound while breathing
Have chest pain and shortness of breath
Suffer from fatigue and unintended weight loss
Find change in the structure of your fingernails or toenails

How can Bronchiectasis be Diagnosed?

Your doctor will first listen to your lungs and check for airway blockage or any abnormal sounds while you breathe. Several tests may be ordered to diagnose the condition, including:

Complete blood test for the possibility of infection and anaemia
Sputum test for the presence of viruses or bacteria or fungi in your mucus
Chest X-ray or CT scan to have a look at your lung structure
Pulmonary test to find out how normally your lungs are functioning
Purified protein derivative (PPD) skin test or QuantiFERON blood test to check for tuberculosis
Sweat test to screen for Cystic Fibrosis (CF), a type of bronchiectasis

What are the Possible Treatments of Bronchiectasis?

Bronchiectasis cannot be cured. However, it can be managed and kept under control by the following methods:

Antibiotic therapy
Mucus thinning therapy
Oxygen therapy
Chest physiotherapy
Pulmonary rehabilitation
Vaccination
Bronchodilators remedy
Expectorants remedy
Breathing exercises
Clinical trials

With early diagnosis and appropriate treatment, you can lead a normal life.

Prevention of Bronchiectasis

In most cases, the exact cause of bronchiectasis cannot be found. Apart from vaccination, avoiding smoking or polluted air or toxic fumes or dust seem to be the best way to prevent bronchiectasis and save your lungs.

What is COPD?

COPD is a progressive and chronic inflammatory disease of your lungs. The condition leads to obstructed airflow from the lungs making it harder for you to breathe.

Common Forms of COPD

There are two common forms of COPD.

Chronic bronchitis: This form involves inflammation of the lining of the bronchial tubes that carry air to and from your lungs. The condition develops over time and is characterised by a long-lasting cough and mucus production.
Emphysema: This is a condition where the air sacs (alveoli) in your lungs weaken over time and eventually break, resulting in the hindrance of outward airflow. You will suffer from shortness of breath, coughing, and exhaustion.

If you have COPD, you are likely to experience both these conditions.

Causes of COPD

The topmost contributor of COPD is tobacco smoking. The other factors include long-term exposure to:

Chemical irritants or fumes
Irritating gases or particulate matters
Fumes from burning fuel
Air pollution
Industrial dust

Who are at Risk of Developing COPD?

You are at risk of developing COPD if you:

Smoke cigarettes long-term
Expose yourself to secondhand smoke frequently
Are a pipe, cigar or marijuana smoker
Have asthma, but continue smoking
Are 40 years and older when the symptoms begin
Suffer from a genetic disorder called alpha-1-antitrypsin deficiency

Symptoms

COPD is a condition that takes a long time to develop. Sometimes, you may not able to notice the progressing COPD until the lungs are damaged significantly. Symptoms of COPD may vary from person to person and can be mild initially but will get progressively worse over time.

The common symptoms of COPD are:

Breathing difficulty (especially during physical activities)
Frequent cold or respiratory infections
A chronic cough with or without white or yellow mucus
Excess mucus production and wheezing
Tightness in the chest
Bluish or grey lips or fingernails (cyanosis)
Lack of energy and signs of fatigue
A feeling of confusion, muddling, and faintness
Unintended weight loss (in advanced stages)
Swelling in legs, ankles or feet

Diagnosis

There is no single test to detect COPD. The diagnosis will begin with a physical examination, based on which, your doctor will order the following tests to get a complete picture of the condition.

Spirometry / lung function test: It is a noninvasive test to assess lung function
Imaging test: This includes X-ray of the chest or CT scan
Arterial blood gas test: This is done to measure your blood oxygen and carbon dioxide

These diagnostic tests will help your doctor to determine the degree of COPD.

Complications of COPD

COPD is known to disturb the airflow to and from the lungs. If untreated, the condition can lead to faster progression of the disease and eventually result in severe respiratory infections, depression, increased risk of heart diseases and lung cancer.

Treatments for COPD

COPD has no cure but is treatable and manageable. The treatment will ease symptoms, reduce the chance of complications, lower the risk of other associated conditions and improve the quality of your life.

Treatments for COPD include but are not limited to the following:

Lifestyle changes
Medications / vaccinations
Supplemental oxygen therapy
Surgery (for severe COPD)
Lung transplantation (very rarely)

Prevention

Though COPD requires longterm management, the first and best way to prevent COPD is to avoid anything that might harm your lungs or cause a flare-up of already overtaxed lungs. For example, you can quit smoking, or use respiratory protection masks to guard against fumes, dust, etc. Following your doctor’s advice will go a long way in keeping your lungs healthy.

What is Shortness of Breath?

Shortness of breath, also known as dyspnea, is discomfort or difficulty in breathing or the inability to get enough air to breathe. It can occur suddenly or gradually over a period of time and can be classified into acute or chronic shortness of breath respectively.

What are the Causes of Shortness of Breath?

The most common causes of shortness of breath are associated with heart and lung conditions and may include:

Asthma
Chronic obstructive pulmonary disease (COPD) flare-up
Stress and anxiety
Allergies to pollen, dust, or mould
Anaemia
Pneumonia
Low blood pressure
Croup
Upper airway obstruction
Pulmonary embolism
Pulmonary hypertension
Pleurisy
Abnormal heartbeats
Enlarged heart
Heart failure
Heart attack

What are the Symptoms Associated with Shortness of Breath?

Symptoms of shortness of breath that require attention by your physician include:

Difficulty breathing when lying flat or with mild activities like walking, climbing stairs, etc
Breathlessness that does not go away even after resting for 30 minutes
Chills, high fever, and cough
Bluish colouration of lips or fingertips
Wheezing – an abnormal whistling sound that occurs on breathing
Stridor – a high-pitched noise that occurs on breathing
Swelling of feet and ankles
Chest pain or chest tightness
Abnormal heart rate
Profuse sweating, exhaustion, or dizziness

What are the Risk Factors of Shortness of Breath?

Some of the commonly known risk factors for shortness of breath may include:

Chronic lung or heart condition
Exposure to asthma triggers
Obesity
Low haemoglobin level
Muscle weakness
Constant stress
Smoking
Not physically fit due to illness or lack of exercise

How is Shortness of Breath Diagnosed?

To determine the underlying cause of your shortness of breath, your doctor will review your symptoms and medical history, perform a physical examination, and may recommend certain diagnostic tests for further verification, including:

Pulmonary function tests
Chest x-ray
Blood tests
CT scan
Electrocardiogram (ECG or EKG)
Echocardiogram
Exercise stress test

How is Shortness of Breath Treated?

Treatment options for shortness of breath are dependent upon the underlying cause and include:

Lifestyle changes, such as refraining from smoking
Avoiding asthma triggers, such as pollen, dust mites, animal dander
Stress reduction through exercise, meditation, etc
Oxygen therapy or pulmonary rehabilitation program
Bronchodilators to relax airways
Breathing techniques
Medications
Weight management

How Can You Prevent Shortness of Breath?

Things you can do to prevent and manage shortness of breath include:

Getting a routine health checkup
Following action plan developed by your physician
Adhering to prescribed medications regularly
Following a healthy lifestyle by avoiding risk factors associated with shortness of breath such as smoking
Avoiding exposure to pollutants in the air, indoors and outdoors
Speaking to your doctor to get acquainted with concerns, worries, or queries related to shortness of breath

What is Lung Cancer?

Cancer is a disease that results from abnormal growth and division of cells that make up the body's tissues and organs.

Under normal circumstances, cells reproduce in an orderly fashion to replace old cells, maintain tissue health and repair injuries. However, when growth control is lost and cells divide too much and too fast, a cellular mass or 'tumour' is formed.

If the tumour is confined to a few cell layers and it does not invade surrounding tissues or organs, it is considered benign. By contrast, if the tumour spreads to surrounding tissues or organs, it is considered malignant, or cancerous. In order to grow further, cancer develops its own blood vessels and this process is called angiogenesis. When it first develops, a malignant tumour may be confined to its original site.

If cancerous cells are not treated, they may break away from the original tumour, travel and grow within other body parts. This process is known as metastasis.

Lung cancer is a growth of abnormal cells inside the lung. These cells reproduce at a much faster rate than normal cells. The abnormal cells stick together and form a cluster or growth, known as a tumour. If the abnormal cells began growing in the lung, this is known as a primary lung tumour.

Types of lung cancer

Depending on how the cells look under a microscope, cancers that begin in the lung are divided into 2 major types:

Non-small cell lung cancer
Small cell lung cancer

Non-small cell lung cancer generally spreads to other organs in the body at a slower rate than small cell lung cancer. Non-small cell lung cancer is the most common type of lung cancer, accounting for almost 80 per cent of lung cancers. Small cell lung cancer accounts for about 20 per cent of all lung cancers.

Causes of Lung Cancer

Cigarette smoking is the major cause of lung cancer. Up to 90 per cent of cases of the disease are caused by smoking, and one in 10 smokers will develop lung cancer. The longer a person has been smoking and the more packs of cigarettes smoked per day, the greater the risk. However, it is not known why one smoker develops lung cancer while another does not.

Research has also demonstrated the link between passive smoking and lung cancer.

Workers exposed to industrial substances such as asbestos, nickel, chromium compounds, arsenic, polycyclic hydrocarbons, and chloromethyl, have a significantly high risk of developing lung cancer.

Symptoms of Lung Cancer

Lung cancer is very difficult to detect at an early stage. Common symptoms include:

New or changing cough, along with hoarseness or shortness of breath or increased shortness of breath during exertion
Recurring episodes of lung infection, weight loss, and swelling of the face or arms.

Treatment for Lung Cancer

There are various treatment options available for lung cancer (with different aims), which include: surgery, chemotherapy, radiotherapy, and laser treatment.

Those non-small cell lung cancers which are amenable to surgery are those where the cancer is confined to a lump in the lung or to the draining lymph nodes immediately next to the lump, but where the lymph nodes in the centre of the chest are involved, it is usually considered not suitable for surgery alone. Investigations include chest X-rays and CT scans. Surgery may involve removal of the lung or part of the lung. For those cancers that spread to the centre of the chest, a combined treatment approach may involve chemotherapy with radiotherapy and surgery. Patients who present with widespread disease or later develop widespread non-small cell lung cancer may undergo chemotherapy which improves the chances of survival

Radiotherapy is used to alleviate the symptoms from primary cancer or other sites of disease, such as the bone.

Small cell lung cancer is primarily treated with chemotherapy. The best outcome is if the disease is confined to the chest, but chemotherapy is still used when the disease is widespread at presentation. Radiotherapy may be used to consolidate the local chest area or to prevent metastases occurring in the brain. Radiotherapy can also be used for palliation of painful localized areas, such as in the bone.

What is Chronic Respiratory Failure?

Chronic respiratory failure is the inability to carry out the fundamental functions of respiration. The lungs function to deliver oxygen to the blood while eliminating carbon dioxide from the blood. It is a condition that usually occurs from narrow or damaged airways that develop gradually over time with a progressive underlying process that requires long-term treatment.

Causes of Chronic Respiratory Failure

Conditions and diseases that affect your breathing can cause chronic respiratory failure and may include:

Pneumonia
Chronic obstructive pulmonary disease (COPD)
Smoking
Drug or alcohol abuse
Chest injury
Cystic fibrosis
Muscular dystrophy
Lou Gehrig’s disease (ALS)
Stroke
Spinal cord complications

Symptoms Associated with Chronic Respiratory Failure

Symptoms of chronic respiratory failure develop over an extended period of time and may include:

Coughing
Wheezing
Shortness of breath
Fast breathing
Headache
Anxiety
Fatigue
Confusion
Bluish colouration of the lips, fingernails, or skin
Abnormal heart rhythm

Diagnosis of Chronic Respiratory Failure

Your healthcare provider will be able to diagnose chronic respiratory failure based on:

Your medical history and symptoms
Your physical examination, which includes looking for signs of bluish colouration of the skin, fingernails, and lips; listening to your lungs to check for abnormal sounds; and listening to your heart to check for irregular or abnormal heart rhythm.
Pulse oximetry test, which is conducted to evaluate how well oxygen is being delivered to various parts of the body. Normal oxygen saturation will range anywhere between 96 to 100 per cent, and anything under 90 per cent would indicate an abnormally low level of oxygen.
Arterial blood gas test, which is conducted to measure the amount of oxygen and carbon dioxide in your blood and any abnormal level would indicate chronic respiratory failure.
Imaging tests, such as chest x-ray or CT scan, to get a better view of your lungs, which may reveal potential causes of chronic respiratory failure.
Bronchoscopy, a thin and flexible lighted instrument that is inserted into your airway and lungs to have a closer look at the lung passages as well as take samples of lung tissue and airway.

How is Chronic Respiratory Failure Treated?

One of the main objectives of the treatment is to get oxygen to your lungs and other organs and remove carbon dioxide from your body. The common treatment options used to achieve these may include:

Ventilator: A breathing machine that pumps oxygen into your lungs and removes carbon dioxide from your lungs through a tube placed into your nose or mouth down into your windpipe.
Oxygen therapy: This therapy raises oxygen levels by increasing the amount of oxygen you inhale by delivering oxygen from a portable tank through a facemask or nasal tube, or a larger tube inserted directly into your windpipe.
Tracheostomy: A surgical procedure where a hole is made through the front of your neck and into your windpipe for a breathing tube to pass through to help you breathe.
Other breathing treatments: Such as noninvasive positive pressure ventilation (NPPV), where mild air pressure is used to keep your airways open while you are asleep. Noninvasive ventilation includes BiPAP as well as CPAP.
IV fluids to improve blood flow throughout your body and medicines for discomfort.

Prognosis of Chronic Respiratory Failure

There is no permanent solution for chronic respiratory failure, however, symptoms can be handled by continuous long-term breathing treatments prescribed by your healthcare provider and diligently following the provided prescriptions.

What is Coronavirus (COVID-19)?

Coronaviruses belong to a large group of viruses that are known to cause severe respiratory illness ranging from the common cold to more serious illnesses such as Severe Acute Respiratory Syndrome (SARS) or Middle East Respiratory Syndrome (MERS) in humans. Coronaviruses are commonly found in animals such as civet cats and camels and are known to be transmitted between animals and humans.

Coronavirus disease COVID-19 is caused by a novel (new) coronavirus (2019-nCOV) that was first discovered in Wuhan, China, in 2019. It has never been previously detected in humans. COVID-19 is highly infectious and one of the most lethal types of coronavirus diseases that has affected people across the globe with total cases of over 766 million and a death rate of over 0.9% to date with no vaccines or medications yet available to treat the deadly virus. Animals as the potential source of COVID-19 have not been confirmed yet and are still under investigation.

Symptoms of Coronavirus (COVID-19)

Some of the common symptoms of coronavirus (COVID-19) include the following:

Fever
Dry cough
Common cold
Body aches
Runny nose
Sneezing
Nasal congestion
Sore throat
Difficulty breathing or shortness of breath
Persistent pressure or pain in the chest

How Does Coronavirus (COVID-19) Spread?

COVID-19 spreads from one person to another through the respiratory droplets. The transmission occurs when:

The respiratory droplets of an infected individual are inhaled by a healthy person
Surfaces or objects with droplets from an infected person are touched by a healthy person and the person then touches their eyes, nose, or mouth. The virus can survive on inanimate surfaces from a few hours up to a few days.

How Long Does It Take to Exhibit Symptoms of COVID-19 After Getting Infected?

The time taken between getting infected and exhibiting symptoms of COVID-19 ranges from 1 to 14 days, but most commonly around 5 days.

Risk Factors for Coronavirus (COVID-19)

Older people and individuals with pre-existing illnesses such as diabetes, high blood pressure, lung diseases, heart conditions, and cancer are more prone to develop serious illnesses than others due to coronavirus infection.

How Can You Protect Yourself and Prevent the Spread of Coronavirus (COVID-19)?

Some of the standard recommendations to protect and prevent the spread of infection include the following:

Cover your nose and mouth when sneezing or coughing with a tissue or your elbow to prevent the spread of droplets.
Clean your hands regularly and thoroughly with soap and water or if not available, use alcohol hand sanitizers.
Wear masks to prevent direct inhalation of droplets from affected individuals.
Practice social distancing by keeping a distance of at least 6 feet from people, especially those who are coughing or sneezing.
Avoid close contact with anyone showing signs and symptoms of respiratory illnesses such as cold and cough.
Stay home and isolate yourself at home from others and avoid public places or crowds.
Consume meat or eggs only after cooking them thoroughly.
Seek immediate medical attention if you exhibit signs and symptoms of coronavirus.
Avoid travelling to places with a high incidence of COVID-19 cases.

For more in-depth information and the current status of COVID-19, we have listed some authoritative websites below for your reference.

https://www.cdc.gov/

https://www.nih.gov/health-information/coronavirus

https://www.who.int/health-topics/coronavirus

https://coronavirus.jhu.edu/

https://www.who.int/emergencies/diseases/novel-coravirusesonavirus-2019/advice-for-public

https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

What is Non-Invasive Ventilation?

Non-invasive ventilation (NIV) refers to the administration of mechanical ventilation to the lungs using methods such as a face mask, without the need of an invasive artificial airway, such as an endotracheal tube (ETT) or tracheal tube (TT).

Invasive ventilation is application of mechanical ventilation via an endotracheal or tracheotomy tube.

Non-invasive ventilation has been used as an alternative to invasive mechanical ventilation (being placed on a ventilator) for people with respiratory failure or chronic respiratory insufficiency who can no longer breathe adequately on their own. In acute settings, NIV delivers effective therapy with less risk of infection and improved survival in patients with respiratory failure.

The growing use of non-invasive ventilation over the last 2 decades to treat respiratory distress has made NIV an integral part in the management of both acute and chronic respiratory failure, in both the home setting and in the hospital setting. The flexibility and comfort offered by non-invasive ventilation make it a valuable addition in the management of patients with respiratory failure.

Main Types of Non-Invasive Ventilation

There are two main types of non-invasive ventilation; positive-pressure and negative-pressure non-invasive ventilation.

In positive pressure non-invasive ventilation, positive pressure is applied to the airway to inflate the lungs directly through a nasal mask, face mask, or nasal plugs. It is the most commonly used non-invasive ventilator mode in the intensive care unit (ICU). CPAP (continuous positive airway pressure) and BiPAP (Bilevel Positive Airway Pressure) are the most common examples of positive-pressure ventilation.

In negative-pressure non-invasive ventilation, negative pressure is applied to the thorax and abdomen to draw air into the lungs through the upper airway using a device that encases the thoracic cage starting from the neck, with devices ranging from a whole-body tank to a cuirass shell. Iron lung or tank ventilator is the most common example of a negative-pressure ventilator.

Indications and Contraindications for Non-Invasive Ventilation

Some of the common indications for non-invasive ventilation include:

Chronic obstructive pulmonary disease (COPD)
Acute asthma exacerbation
Immunocompromised patients
Acute cardiogenic pulmonary oedema
Acute respiratory failure
Decompensated heart failure
Palliative care
Acute deterioration of disorders associated with sleep hypoventilation

Some of the common contraindications for non-invasive ventilation include:

Respiratory or cardiac arrest
Hypoxemia
Facial surgery, trauma, or deformity
Untreated pneumothorax
Haemodynamic instability
Inability to protect airway or clear secretions
Agitated or uncooperative

Eligibility Criteria for Non-Invasive Ventilation

Some of the criteria that need to be fulfilled prior to beginning NIV treatment include:

Ability to protect his or her airway
Adequate level of consciousness, with the exception of hypercapnic COPD patients
Expected level of compliance with non-invasive interface
Ability to manage respiratory secretions
Ability to recover to a quality of life of acceptable standard

Failure to fulfil any one of these criteria contributes to the patient being considered ineligible for NIV.

Mechanisms of Action of Non-invasive Ventilation

The favourable effects of non-invasive ventilation in patients with acute respiratory distress include:

Reduction in inspiratory muscle work and avoidance of respiratory muscle fatigue
Increases the volume of air moved into and out of the lungs during each breathing cycle
CPAP counterbalances the energy expended to inhale and exhale a breathing gas by delivering constant and steady air pressure by keeping the airways continuously open
NIV improves respiratory system compliance by reversing microatelectasis (complete or partial collapse of the lung)
Enhances cardiovascular function

Benefits of Non-Invasive Ventilation

Some of the benefits of non-invasive ventilation when compared with invasive ventilation include:

Prevents resistive work of breathing imposed by an endotracheal tube
Prevents complications associated with endotracheal tube intubation, such as aspiration, trauma, and injury to the trachea, larynx, or hypopharynx
Decreases infectious complications, such as pneumonia, sepsis, or sinusitis
Enhances patient comfort
Decreases the need for sedation
Allows intermittent use
Protects speech, swallowing, and expectoration
Flexibility in wearing and removing mechanical ventilation
Less cost

Risks and Complications of Non-Invasive Ventilation

Some of the risks and complications associated with non-invasive ventilation include:

Gastric distension
Facial skin necrosis
Air leakage through mask
Eye irritation
Transient hypoxemia (abnormally low level of oxygen in the blood)
Lack of airway access and protection
Increased initial time engagement
Delayed correction of gas exchange irregularity

What is Bronchoscopy?

Bronchoscopy is a procedure used to evaluate the airways, lungs or lymph nodes in the chest for abnormalities and to treat conditions such as abnormal growths or foreign bodies causing airway obstruction.

Types

There are two types of bronchoscopes that may be used: Flexible and Rigid.

Flexible bronchoscopy uses a long, thin, flexible lighted tube that can access the small airway branches. A sample of tissue or a biopsy may be obtained through the bronchoscope for laboratory study.

Rigid bronchoscopy involves the use of a rigid, straight, hollow metal tube. Rigid bronchoscopy is indicated when the airway is obstructed by blood or foreign objects.

Indications

Bronchoscopy is commonly performed to evaluate abnormal findings on a chest X-ray or CT scan and obtain biopsies for further studies. It may also be used to diagnose airway problems such as:

A Persistent cough.
Difficulty breathing.
Blood in the sputum and.
Lung cancer.

Pre-procedural preparation

Inform your doctor if you are pregnant or allergic to any medications. Other tests may also be ordered prior to the procedure. To reduce the risk of bleeding, you will have to discontinue taking blood thinning medications and non-steroidal anti-inflammatory drugs a few days before the procedure. You should abstain from food and drink after midnight before the procedure and if instructed to take medications, you should do so only with a sip of water.

Procedure

During a bronchoscopy, your blood pressure, oxygen level and heart rate are continually monitored.

Flexible bronchoscopy may be performed with you lying on your back or in a reclined or upright position. A sedative will be administered to help you relax and an intravenous line will be inserted for additional medications. A local anesthetic will be sprayed into your nose and mouth to reduce your gag reflex and minimize discomfort from insertion of the bronchoscope. In case of narrow nasal passages, the tube may be inserted through your mouth. The bronchoscope is gently inserted past the vocal cords and trachea into your lung while your doctor looks for abnormalities. Instruments are passed through the bronchoscope and guided by X-ray imaging to obtain tissue and fluid samples or to perform other procedures. Your airway will then be washed with a saline solution.

A rigid bronchoscopy is performed under general anesthesia. Your neck is extended and the bronchoscope is gently inserted through your mouth and windpipe. Biopsy samples are obtained and the airway is washed with saline.

Post-Procedural Care

Following the procedure, you should avoid drinking or eating for at least 2 hours. Starting with small sips of water you can then gradually resume a normal diet. Avoid smoking for at least 24 hours after the procedure. You should not drive, drink alcohol or operate machinery for 24 hours after receiving the sedative. You may experience a sore throat which can be soothed by warm salt water gargles or throat lozenges. Consult your doctor immediately if you have breathing problems, persistent fever, or significant bleeding.

Risks and Complications

Bronchoscopy is generally a safe test but as with any procedure complications may occur and can include:

Breathing impairment.
Arrhythmias or irregular heart rhythms.
Infection such as pneumonia.
Hoarseness.
Tear in the lung or bleeding due to a biopsy instrument.

What is a Chest Infection?

A chest infection is an invasion of pathogens affecting the bottom part of your respiratory tract (lungs) including the windpipe, bronchi, and lungs. Infections can range from mild to severe. Pathogens may include bacteria, viruses, fungi and parasites that are not normally present within the body.

Types of Chest Infection

There are two common types of chest infection, including:

Bronchitis (affects larger airways)
Pneumonia (affects smaller air sacs): It is more common in winter and spring

What Causes a Chest Infection?

Chest infection is mostly caused by viruses, but occasionally by bacteria or fungi. Bronchitis is mostly caused by a virus, while bacteria cause pneumonia in most cases.

Who are at Higher Risk of Developing Chest Infection?

Sections of the people who are more prone to chest infection include:

Elderly people
Obese people
Pregnant women
Babies or young children
Children suffering from developmental problems
Smokers

Additionally, those who have chronic health conditions such as COPD, asthma, diabetes, heart/kidney disease, weakened immune system, etc., are also at a higher risk of chest infection.

Symptoms of a Chest Infection

There are several symptoms you are likely to experience if you have a chest infection. However, the major symptoms are a high temperature with difficulty in breathing and coughing up yellow or green mucus. You may have a chest infection if you experience:

A headache and discomfort/pain in your chest
Chesty cough (wet or phlegmy)
Wheezing and chronic coughing (lasting more than three weeks)
Loss of appetite
Muscle aches and pains
Tiredness and lethargy

Diagnosis of a Chest Infection

There are several ways your doctor can diagnose a chest infection. To start with, your doctor uses a stethoscope and listens to your heart and lungs while you breathe. Subsequently, you doctor may conduct the following evaluations based on the severity of the condition:

Symptoms evaluation and physical examination
Chest X-ray (to determine the location and severity of the infection)
Sputum/phlegm or even blood sample examination (to determine the cause of the infection)

Treatment for a Chest Infection

Home remedies/self-help

Sometimes, if the infection is bronchitis, it may go away on its own or else you may visit a pharmacist who will help you with some over-the-counter (OTC) decongestant medications. Other remedies include:

Drinking lots of fluids and taking rest
Not lying flat while sleeping
Using inhaled steam vapour or humidifier
Consuming a warm drink of lemon and honey
Staying away from smoking

Medical treatment

If the infection is severe and cannot be cured by a home remedy, you must visit your doctor for further treatment. The cause of the infection is the basis for the type of treatment prescribed.

If a virus has caused the infection, antibiotics will be ineffective. The treatment should focus on easing your symptoms until you start to get better. In case the infection is of bacterial origin, your doctor can treat you with relevant antibiotics till you recover fully. You may be given tablets if the infection is mild. If not, hospital admission may be necessary for IV antibiotics treatment.

Prognosis of Chest Infection

Most symptoms usually go away within 7 to 10 days, although a cough can last up to three weeks. If the infection is viral in nature, it will settle over time. If it is bacterial, you will start feeling better one or two days after starting on antibiotics. Even though you may begin to feel better, always remember to complete the full course of antibiotics.

How Can You Prevent a Chest Infection?

Some of the tips that can help you prevent a chest infection include:

Keeping your hands clean before taking food or touching your mouth
Getting vaccinated as recommended by your doctor
Eating a well-balanced diet to boost your immune system
Avoiding smoking and reducing alcohol consumption

Early detection of lung cancer following lung health screening has higher rate of survival.
Currently, lung cancer screening is not currently available on the NHS to all; private lung cancer
screening can be useful for at high-risk who don’t show any symptoms.

What is cancer screening?

Screening means testing people for early stages of a disease. This is before they have any
symptoms.

Who should opt for lung cancer screening?

• Individual who are aged between 55 and 74
• and either smoke or used to smoke

Possible benefits of lung cancer screening
There is evidence that screening people based on their risk of lung cancer can save lives. The
initial assessment helps to work out who is at higher risk of lung cancer and might benefit from
having a CT scan.
Diagnosing lung cancer early means that treatment is more likely to work.

Symptoms to look out for

• having a new cough or a cough most of the time
• getting out of breath doing the things you used to do without a problem
• coughing up phlegm (sputum) with blood in it
• feeling tired all the time (fatigue)
• having an ache or pain in the chest or shoulder

The evidence for lung cancer screening

Early detection makes it more likely that treatment can begin before the cancer has spread, so
survival rates are much higher.
Major US-based organisations, including the American College of Chest Physicians, the
American Cancer Society, the National Comprehensive Cancer Network and the American
Society of Clinical Oncology, reviewed the evidence early in 2012.
On the basis of this review, they now recommend that people should be screened for lung
cancer using low-dose CT scans and follow up if they:
The National Health Service has started to roll out screening programme too.

Lung Cancer Screening

Early detection of lung cancer through screening significantly increases survival rates. While
comprehensive lung cancer screening is not universally available on the NHS, private screening
can be particularly beneficial for high-risk individuals, even if they show no symptoms.

Cancer Screening Overview

What is it ?
Screening involves testing people for early stages of a disease before they exhibit any
symptoms.

Who should consider it?
Individuals aged between 55 and 74 who either currently smoke or have smoked in the past.

Benefits:
Evidence suggests that screening based on lung cancer risk can save lives by facilitating early
diagnosis and treatment.

Symptoms of Lung Cancer

- Persistent new cough or a long-standing cough.
- Shortness of breath during activities that were previously manageable.
- Coughing up blood-tinged phlegm.
- Constant fatigue.
- Chest or shoulder pain.

Evidence for Lung Cancer Screening

Major US organizations such as the American College of Chest Physicians, the American
Cancer Society, and others have recommended lung cancer screening using low-dose CT scans
based on evidence that early detection improves survival rates. The NHS is also beginning to
implement a screening program.

Dr. Shalin Diwanji

MBChB, MD, FRCP

Obstructive Sleep Apnoea: When to See a Specialist

What is obstructive sleep apnoea?

What causes obstructive sleep apnoea?

What are the possible symptoms of obstructive sleep apnoea?

Do I need to see a specialist for obstructive sleep apnoea?

How is obstructive sleep apnoea diagnosed?

How is obstructive sleep apnoea treated?

Considering a Specialist Respiratory Opinion?

Concerned about your breathing or lung health?

Conditions We Treat:

Consultant Respiratory Physician

Dr Shalin Diwanji