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04/Jul/2022

Do asthma drugs affect pregnancy Asthma control may alter during pregnancy, so it’s important to keep an eye on it.

1/3 – same, 1/3 – deteriorate, 1/3 – improve

Risk to a fetus is more in poorly controlled asthma as compared to the risk of medications. Inhaled glucocorticoids, theophylline, beta-2 agonists, and leukotriene inhibitors are not associated with any fetal anomalies.

Do Asthma Drugs Affect Pregnancy | Can Heartburn be Worse Than Asthma?

Yes in many studies it has been shown that heartburn worsens asthma and proton pump inhibitors have been shown to improve asthma control. In severe GERD, surgery may also be need to control asthma symptoms. However, routine use of PPI in asymptomatic GERD in asthmatics is not of any benefit.

What is difficult asthma?

It was in 1998 that Peter Barnes gave the concept of difficult asthma. Most asthmatics are control with ICS. But 5% are not control. Now BTS & GINA have also defined difficult asthma.

Asthma symptoms not controlled by step 4 medications (reliever + 2 or more controllers)

  1. Recheck diagnosis of asthma
  2. Adherence
  3. Smoking history – present or past
  4. Co-morbidities – GERD, sinusitis, obesity, sleep apnea

 

What is steroid-resistant asthma?

Glucocorticoids (GCs) have potent anti-inflammatory actions and are the most effective agents in the treatment of asthma. Asthmatics have 2 spectrums of disease steroid-responsive at one end and steroid-resistant at the other end. Patients with chronic asthma who are unresponsive to high doses of GCs and are without confounding factors have been termed GC-resistant.

There is no known treatment for glucocorticoid-resistant asthma. Treatment strategies include the use of higher doses of systemic glucocorticoids for a longer duration, nonglucocorticoid agents (eg, beta-adrenergic agonists, anticholinergic agents, anti leukotriene agents, omalizumab, cromolyn) and nonpharmacologic therapies (eg, trigger avoidance, bronchial thermoplasty). Small clinical trials of anti-interleukin (IL)-5 and anti-IL-13 have showed some benefit in GC-resistant asthma patients, but many of these innovative medicines require additional evidence of clinically relevant effects.

What are allergy shots?

Allergy shots are another name for immunotherapy. Subcutaneous or sublingual administration is possible. The ideal patient for IT should be more than 5 yr, with mild to moderate disease, few dominant allergens, seasonal exacerbations, patients on daily prophylactic medicines (wants to take less), and improved QOL. Not appropriate <5yr, >60 yr, h/o anaphylaxis, lack of availability of well-tested allergens.

Long-term effects of IT persist even after IT is discontinue.

SLIT: less effective than SCIT,

Safer but not totally

Shown effective as monotherapy

Dosing issues persist

Not shown to be effective in a mixture of antigens

Not yet approved in our country

Is asthma a lifelong problem or can it be cured?

There are 2 types of asthma. Half of the children who develop asthma in childhood outgrow their symptoms when they reach the age of 14-15 y. However, they may develop symptoms in later life when exposed to heavy trigger factors.

Your message for an asthmatic?

Asthma is a controllable disease and you can lead a trouble-free life with 2 Asthma Treatment strategies. 

1. KEEP PRECAUTIONS OF TRIGGER AVOIDANCE 

2. TAKE YOUR MEDICINES REGULARLY

Intrinsic (non-atopic) asthma and extrinsic (atopic) asthma)

There is no clinical or serological evidence of IgE-mediated allergy to common environmental stimuli in intrinsic asthma. When compared to controls, bronchial biopsies from such patients demonstrate increased expression of Th2-type cytokines, CC chemokines, and I/C, similar to extrinsic asthma. These data show that in this key clinically different type of the disease, there may be local IgE production directed against unknown antigens, presumably of viral origin or even autoantigens.


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04/Jul/2022

Many cells and cellular factors play a part in this chronic inflammatory condition of the airway. Chronic inflammation is associated with airway hyperresponsiveness which is responsible for chest tightness, wheezing, and coughing, particularly at night or in the early morning. What is asthma, These article are associated with widespread but variable airway obstruction within the lung that is often reversible either spontaneously or with treatment.

What is asthma? How is asthma diagnosed?

Symptomatic asthma – PFT, Asymptomatic – provocation challenge test Symptoms: episodic breathlessness, chest tightness, wheezing, cough – incited with allergen exposure, seasonal variation. There is a family history of asthma and allergy. History of variability in symptoms. Physical examination – wheezing may be present, silent chest in severe asthma

Lung functions – FEV1, FVC, PEFR

PEFR – 1. Confirm diagnosis of asthma (>20% or >60l/min improvement post-bronchodilator or diurnal) 2. For monitoring and control

Methacholine challenge test/ histamine challenge test/ mannitol/exercise challenge test (sensitive test – negative test rules out asthma, false-positive – allergic rhinitis, CF, bronchiectasis, COPD)

Sputum eosinophilia, Feno

Total Ig E – not diagnostic of atopy

SPT – low cost and high sensitivity through false positive is high

Rule out DD –

FOREIGN BODY INHALATION

VOCAL CORD DYSFUNCTION

LVF

COPD

CF/BRONCHIECTASIS

How do u assess the severity

 Controlled
(ALL MEASURES)
Partly controlled
(1-2)
Uncontrolled
Daytime symptoms<2 /week3 OR MORE
Limitation of activityNone
Nocturnal awakeningNone
Need for reliever<2 /week
FEV1N<80%

Assessment of future risk –

  1. Poor control of symptoms
  2. Frequent exacerbations
  3. ICU admissions
  4. Low FEV1
  5. Cigarette smoke exposure
  6. High dose medications

 

Old classification of patients – intermittent, mild persistent, moderate persistent, severe persistent

It is not only the severity of symptoms but its responsiveness to treatment.

What is an asthma attack?

Many patients have stable disease and they are relatively free of symptoms. But whenever they come across trigger factors they develop an increase in their symptoms.

Asthma attack comprises the episode of progressive increase in breathlessness, cough, chest tightness, and wheezing. Treatment comprises repeated doses of rapid-acting bronchodilators, systemic steroids, and oxygen if required. Milder exacerbations can be treated in community settings

What causes these symptoms?

Asthma is an inflammatory disease with the involvement of airway cells (like mast cells, eosinophils, t lymphocytes, and dendritic cells) and structural cells (airway epithelial, endothelial cells, smooth muscle cells). Chemokines, cysteinyl leukotrienes, cytokines, histamine, and NO are mediators that act on these cells.

Airway narrowing is caused due to – smooth muscle contraction, airway edema, mucus hypersecretion, airway remodeling.

What signs tells a person that asthma is worsening ?

1. Breathlessness

2. Talks in 

3. Alertness

4. Wheeze

5. Respiratory rate

6. Accessory muscles of respiration

7. Pulse

8. Pulsus paradoxus

9. PEFR

10. SpO2

11. PaO2

12. PaCO2


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04/Jul/2022

Inhalers are the most useful way for people with asthma and other lung diseases to access life-saving drugs. If you suffer from asthma or you care for someone who has asthma, here’s all you need to know about inhalers, including how to use them correctly and Advantages and Disadvantages of inhaler.

Advantages and Disadvantages of inhaler

Inhalers for asthma are small, mobile devices that administer medication to the lungs. To assist control asthma symptoms, a range of asthma inhalers are available. You can receive the medication you need to prevent or treat asthma attacks if you find the right one and use it correctly.

Inhaler technique | How to Use Inhaler

Inhalers are devices to deliver medications for the treatment of obstructive airway disease including asthma and chronic obstructive airway disease (COPD). There are different types of inhalation devices primarily including dry powder inhalers (DPI) and metered-dose inhalers (MDI). It is essential to take the inhaler properly, if not taken properly the medication would not reach the proper site.

Advantages of inhaler

The dose of medication in the inhaler is almost one-tenth of the dose taken in oral form. The response to medication is quick. Since oral absorption is minimal, side effects are not significant for the inhaler. Side effects are thus minimal, the response is quick and better.

Disadvantages of inhaler 

There is some oral deposition that leads to oral ulcers, candidiasis, and dysphonia. However, all these side effects can be avoided if the mouth is rinsed thoroughly after inhalation.

Advantages of a spacer

The spacer is a device to be placed between the mouth and the MDI. The extra medicine deposits in the spacer, thereby oral deposition is very less. Thus, the above-mentioned side-effects are also very few.

How to take a DPI?

  1. First, put the capsule in the device
  2. Rotate the device till the capsule breaks
  3. Blow out completely
  4. Take the mouthpiece in the mouth and seal it with lips
  5. Fast and deep breath in
  6. Hold for 10 seconds
  7. Blow out completely
  8. Rinse mouth

How to take MDI with a spacer?

  1. Shake inhaler
  2. Fix it in the spacer
  3. Blow out completely
  4. Take the mouthpiece in the mouth and seal it with lips
  5. Slow and deep breath in
  6. Hold for 10 seconds
  7. Blow out completely
  8. Rinse mouth

Myths and facts about inhaler

  1. It is habit-forming – FALSE

Truth – It is a requirement not addicting

  1. It has many side effects – FALSE

Truth – It causes lesser side effects than oral medicines


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04/Jul/2022

There has been an increase in asthma patients in recent times. Asthma is a disease of the respiratory tract of the lungs, in which it is difficult to breathe. There are many causes for shortness of breath. Breathlessness can also occur due to lack of blood in the body, heart disease, kidney failure, or excess body fat (obesity). However, it’s not asthma. Inflammation of the airways inside the lungs reduces their diameter. Increased secretion causes the vessels to constrict. Now we discuss How Asthma is Treated, it is difficult to breathe at such times. Overall this is a lung disease.

How Asthma is Treated, Asthma symptoms, causes, and diagnosis

Inflammation of the respiratory tract and internal secretions interfere with the functioning of the lungs. It makes you breathless. In times like these it is more difficult to do what we used to do. In the past, climbing a floor in a house was not easy; But then, even if he climbs one floor, he gets breathless. It can be an asthma attack. In addition, dust from flying while doing housework makes breathing difficult. This dust contains many allergenic ingredients. Chief among them is ‘House Dust Mite. Many people suffer from allergies and asthma due to dust. 

Frequent colds and coughs.

Flatulence is also a symptom. Often no such signs are found; There is only coughing. At such times there is only a cough, so ignore it. However, this cough may be due to asthma. Symptoms such as regular coughing, hoarseness, and chest tightness are more common in asthma.

Causes of asthma

There are many causes of asthma. Heredity is a major cause of asthma. If someone in the house has asthma, other members are more likely to have asthma. Allergies are a major cause of asthma. If one becomes allergic to something and comes into contact with that thing repeatedly or consumes things that are allergic, then certain, components in the blood increase. It contains an element called eosinophils, which causes swelling in the airways. Asthma and asthma are closely related. Winter or cold weather, dusty and polluted environments are also conducive to asthma.

How is asthma diagnosed?

Environmental pollution also causes asthma. In addition, bronchitis, prolonged coughing can cause shortness of breath. Smoking causes asthma. In addition, regular viral infections (swine flu and now covid-19) are causing asthma. Asthma is more likely to be caused by a person who is constantly working in the smoke, painting business or spray paint, mining, construction. However, its long-term effects are reflected in how long it lasts, how much it affects the lungs, and how strong the immune system is.

Some tests are needed to diagnose asthma. If you experience frequent colds, sneezing, hoarseness, or cold-cough when the weather changes, you need to see a doctor immediately. Doctors diagnose asthma through a medical examination. At this time, he asks if anyone in the family has asthma. Your breathing capacity is checked by a device called a ‘peak-flow’ meter. Therefore, a preliminary diagnosis of asthma can be made.

Lung function test (spirometry): A lung function test is a lung function test to diagnose asthma. This is called ‘spirometry’. Other tests include blood tests, X-rays, oxygen levels, and other ailments to check for shortness of breath. Asthma can be diagnosed by removing the echo if it causes a heart attack.

Best Doctor in Jaipur for Asthma Treatment

Asthma is treated based on patient history. Different patients have different types of allergies. Doctors for Asthma treatment are easily available in Rajasthan. But When we talk about Best Doctor for Asthma Treatment in Jaipur then only Dr.Sheetu Singh’s name will come into our mind. She is an expert in her field. She treats Asthma very well.


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04/Jul/2022

Chest Specialist in Jaipur: Dr. Sheetu Singh is one of the best Chest Specialists in Jaipur. Chest Pain is normally ascribed to heart disease people, who are suffering from heart disease and experienced dubious irritation, in which chest pain does not seem to be enough explanation. Generally, it describes any heart problem or heart attack that may be associated or characterized with any one of the following points:

Chest Specialist in Jaipur, Top Pulmonologists Doctors

  • Tightness, pressure, or fullness in your chest area.
  • Cold Sweats
  • Breathing issue or shortness of breath
  • Vomiting or nausea
  • Weakness or Dizziness
  • Extreme Chest pain that spread out into your arms, back, jaw, shoulders, neck.
  • Feeling pain that is getting worse with your routine activity and then it goes away, again come back.

Diagnosis and Test

If random pain occurs in your chest then it doesn’t mean that it is giving the signal of a heart attack. You need to be immediately concerned with the Chest Specialist in Jaipur. But in the emergency room, a specialist will check for a heart attack first only to confirm that your life is not in danger. Then they check other symptoms such as any clot in your lung or collapsed lung. Doctors performed some immediate or life-saving test such as:

ECG (Electrocardiogram): In this test electrodes is attached to your skin and by this machine, the doctor monitors the electrical activity of your heart. When the heart muscle is injured, the electrical impulses generate the electrodes do not seem normal, the ECG being the best way to identify a heart attack is occurred or not. For any query or detailed information click here: https://www.drsheetusingh.com

Blood Test: In our heart muscle, some enzymes are found so by performing the blood test, the doctor checks the increment level of enzymes. When heart cells in injured, then these enzymes will leak into your blood due to a heart attack over hours.

X-Ray Test: X-Ray will tell the doctor about the condition of your lungs, major blood vessels, or the shape and size of your heart. If your lung has a certain issue such as a collapsed lung or pneumonia, on an X-Ray report doctor can check out these issues.


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