Pulmonology / Chest Medicine

 

Pulmonology/ Chest Medicine / Respiratory Medicine is a subspecialty of Internal Medicine that focuses on the diagnosis and treatment of patients with illnesses that affect the lungs and breathing. A Pulmonologist has expertise in the evaluation of patients with symptoms like breathlessness, cough, chest pain, wheezing, chest tightness, snoring & sleepiness, coughing out blood as well as abnormalities of the chest x-ray, chest CT scan and other chest imaging studies.

Ruby General Hospital has an advanced dedicated Pulmonology department providing Comprehensive, Consultative, Diagnostic and Therapeutic Services under one roof. It is a unit designed for prevention & early detection of respiratory diseases, performing required Interventions and providing Pulmonary Rehabilitation to help patients with respiratory illnesses to lead healthier and productive lives. Our vision is a society whose respiratory health permits a long and productive life. The latest technology is used to provide state-of-the-art care in both the Outpatient and Hospital settings, including the Intensive Care Units.

 

FACILITIES AVAILABLE

  • Outpatient clinics for evaluation and treatment of various lung conditions.

  • Hospital inpatient services for evaluation and treatment of various lung conditions.

  • Respiratory Critical Care - Emergency & Intensive care services for treatment of the critically ill.

  • Sleep disorders evaluation and treatment.

  • Interventional Pulmonology :
    Diagnostic Flexible Video Bronchoscopy, Bronchoalveolar Lavage (BAL), Endobronchial Biopsy, Fluoroscopy guided Transbronchial Biopsy (TBLB), Transbronchial FNAC (cTBNA),

  • Therapeutic Flexible Video Bronchoscopy & Rigid Bronchoscopy, Foreign Body Removal, Airway Stenting, Management of Malignant & Non malignant Central airway obstructing lesion, Endobronchial Glue Therapy for Hemoptysis & Bronchopleural Fistula

  • EBUS / Endobronchial Ultrasonography TBNA(planned shortly)

  • CT and USG guided FNAC, Trucut Biopsy

  • Ultrasound guided Pleural Aspiration, Intercostal Drainage

  • Medical Thoracoscopy

  • Pulmonary Function Laboratory :

    • Spirometry (with Bronchodilator Reversibility)

    • FENO (Fractional Exhaled Nitric Oxide)

    • DLCO (Diffusing capacity of the Lungs for Carbon Monoxide)

    • Lung Volumes

    • 6 minutes walk test

    • CO Check

    • Pulmonary Rehabilitation Program

  • Quit Smoking program

  • Laboratory investigation of blood (blood tests), ABG ( Arterial Blood Gas)

  • Chest X-rays

  • CT scanning including LDCT (Low Dose screening CT for early lung cancer screening), HRCT, MDCT, Virtual Bronchoscopy.

  • Level II & III Polysomnography (split night & double night sleep studies) for the diagnosis & therapy of Obstructive Sleep Apnea (OSA)

  • Option of attending Obesity Clinic & Bariatric (Obesity) Surgery available now

 

Our Pulmonary specialists have expertise in a range of respiratory conditions including but not limited to:

  • Management of all Respiratory Emergencies & Acute Critical conditions

  • ASTHMA & ALLERGIC LUNG DISORDERS (including ASPERGILLOSIS and ABPA)

  • LUNG CANCER

  • CHRONIC OBSTRUCTIVE LUNG DISEASE (COPD)

  • Disorders of the PLEURA (including MESOTHELIOMA, PLEURAL EFFUSION, EMPYEMA AND PNEUMOTHORAX)

  • INTERSTITIAL LUNG DISEASE (ILD), SARCOIDOSIS

  • EBUS / Endobronchial Ultrasonography TBNA(planned shortly)

  • CT and USG guided FNAC, Trucut Biopsy

  • Ultrasound guided Pleural Aspiration, Intercostal Drainage

  • Medical Thoracoscopy

  • Asbestos related conditions (including ASBESTOSIS, MESOTHELIOMA) & other OCCUPATIONAL RESPIRATORY DISEASES

  • TUBERCULOSIS (TB)

  • SLEEP DISORDERED BREATHING (including Obstructive Sleep Apnea / OSA)

  • PNEUMONIA, BRONCHITIS

  • BRONCHIECTASIS

  • PULMONARY HYPERTENSION

  • PULMONARY HAEMORRHAGE

  • PULMONARY EMBOLISM

  • Pulmonary manifestations of systemic disease

  • CYSTIC FIBROSIS and other Genetic and developmental lung disorders

Now we are in a tie up with Revised National Tuberculosis Control Program (RNTCP) through Joint Effort for Elimination of Tuberculosis (JEET) in pledge for elimination of Tuberculosis (TB) by 2025, thus, providing CBNAAT & Rapid TB CULTURES FREE OF COST.

 

Pulmonary Rehabilitation

 

Pulmonary rehabilitation, also known as respiratory rehabilitation, is an important part of the management and health maintenance of people with chronic respiratory disease who remain symptomatic or continue to have decreased function despite standard medical treatment. It is a broad therapeutic concept. It is defined by the American Thoracic Society and the European Respiratory Society as an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. In general, pulmonary rehabilitation refers to a series of services that are administered to patients of respiratory disease and their families, typically to attempt to improve the quality of life for the patient. Pulmonary rehabilitation may be carried out in a variety of settings, depending on the patient's needs, and may or may not include pharmacologic intervention.

 

Medical uses

The NICE clinical guideline on chronic obstructive pulmonary disease states that “pulmonary rehabilitation should be offered to all patients who consider themselves functionally disabled by COPD (usually MRC [Medical Research Council] grade 3 and above)”. It is indicated not only in patients with COPD, but also in:

  • Cystic fibrosis
  • Bronchitis
  • Sarcoidosis
  • Idiopathic pulmonary fibrosis
  • Before and after lung surgery

It appears not to be harmful and may be helpful for interstitial lung disease

 

Aim

  • To reduce symptoms

  • To improve knowledge of lung condition and promote self-management

  • To increase muscle strength and endurance (peripheral and respiratory)

  • To increase the exercise tolerance

  • To reduce length of hospital stay

  • To help to function better in day-to-day life

  • To help in managing anxiety and depression

 

Benefits

  • Reduction in number of days spent in hospital one year following pulmonary rehabilitation.

  • Reduction in the number of exacerbations in patients who performed daily exercise when compared to those who did not exercise.

  • Reduced exacerbations post pulmonary rehabilitation

 

Weaknesses addressed

Ventilatory limitation

  • Increased dead space ventilation

  • Impaired gas exchange

  • Increased ventilatory demands due to peripheral muscle dysfunction

 

Gas exchange limitation

  • Compromised functional inspiratory muscle strength

  • Compromised inspiratory muscle endurance

 

Cardiac dysfunction

  • Increase in right ventricular afterload due to increased peripheral vascular resistance.

 

Skeletal muscle dysfunction

  • Average reduction in quadriceps strength decreased by 20-30% in moderate to severe COPD

  • Reduction in the proportion of type I muscle fibres and an increase in the proportion of type II fibres compared to age matched normal subjects

  • Reduction in capillary to fibre ratio and peak oxygen consumption

  • Reduction in oxidative enzyme capacity and increased blood lactate levels at lower work rates compared to normal subjects

  • Prolonged periods of under nutrition which results in a reduction in strength and endurance

 

Respiratory muscle dysfunction

  • Pulmonary rehabilitation is generally specific to the individual patient, with the objective of meeting the needs of the patient. It is a broad program and may benefit patients with lung diseases such as chronic obstructive pulmonary disease (COPD), sarcoidosis, idiopathic pulmonary fibrosis (IPF) and cystic fibrosis, among others. Although the process is focused on the rehabilitation of the patient him/herself, the family is also involved. The process typically does not begin until a medical exam of the patient has been performed by a licensed physician.

  • The setting of pulmonary rehabilitation varies by patient; settings may include inpatient care, outpatient care, the office of a physician, or the patient's home.

  • The goal of pulmonary rehabilitation is to help improve the well-being and quality of life of the patient and their families. Accordingly, programs typically focus on several aspects of the patient's recovery and can include: - Medication management - Exercise training - Breathing retraining - Education about the patient's lung disease and how to manage it - Nutrition counseling - Emotional support.

 

Pharmacologic intervention

  • Medications may be used in the process of pulmonary rehabilitation including: Anti-inflammatory agents (inhaled steroids), Bronchodilators, Long-acting bronchodilators, Beta-2 agonists, Anticholinergic agents, Oral steroids, Antibiotics, Mucolytic agents, Oxygen therapy, or Preventative therapy (i.e., Vaccination).

 

Exercise

  • Exercise is the cornerstone of pulmonary rehabilitation programs. Although, exercise training does not directly improve lung function, it causes several physiological adaptations to exercise which can improve physical condition. There are three basic types of exercises to be considered. Aerobic exercise tends to improve the body's ability to use oxygen by decreasing the heart rate and blood pressure. Strengthening or resistance exercises can help build strength in the respiratory muscles. Stretching and flexibility exercises like yoga and Pilates can enhance breathing coordination. As exercise can trigger shortness of breath, it is important to build up the level of exercise gradually under the supervision of health care professionals (e.g., respiratory therapist, physiotherapist, exercise physiologist). Additionally pursed lip breathing can be used to increase oxygen level in patient's body. Breathing games can be used to motivate patients to learn pursed lip breathing technique.