Respiratory system Problems in GP

Respiratory Problems in GP
Opaque Patch of
Pneumonia Presented By
• Prof.Dr.
• R.R.Deshpande
• 9226910630
8/8/2015 Prof.Dr.R.R.Deshpande 1

• Presented By –
• Prof.Dr.R.R.Deshpande (M.D in Ayurvdic
Medicine & M.D. in Ayurvedic Physiology)
• www.ayurvedicfriend.com
• Mobile – 922 68 10 630
• Mailme.drrrdeshpande@rediffmail.com

• 1) Acute Rhinitis
• 2) Hoarseness of voice
• 3) Acute bronchitis
• 4) Chr bronchitis
• 5) Pneumonia
• 6) TB
• 7) Br. Asthama
• 8) Bronchieactesis
• 9) Emphysema

Causes of Cough
• 1) Respiratory causes
• 2) Cardiac
• 3) Mediastinal
• 4) Drugs
• 5) Miscellaneous

Investigation for Cough
• 1) Haemogram ESR
• 2) Stool Routine
• 3) Chest X – ray (PA view) (priorly for
pleurisy, pneumonia or T.B.)
• 4) AFB – Acid Fast bacilli –
Mycobacterium Tubercle
• 5) Consecutive 3 days sputum
examination is done
• 6) Bronchoscopy

Medicines of Cough
• 1) Allergy – Anti Allergy
• 2) Antibiotic
• 3) Anti tussive – dry cough
• 4) Expectorant – for productive cough
• 5) Mucolytic – for breaking mucoid ,sticky fibers
• 6) Bronchodiator
• 7) Steroids
• 8) Anti-pyretic & Anti inflammatory NSAIDS
• 9) Avoids Irritants
• 10) Steam Inhalation.

Note Carefully
• In Respiratory & GIT problems use of
Ayurvedic Medicines show 80 % more
better results than Allopathy
• Above age – 50 years sudden change in
voice and no response to treatment then
refer to ENT surgeon for laryngoscopy
(laryngeal cancer)

1) Allergic Rhinitis
• Short attacks of severe sneezing and
running of nose.
• Allergen – Pollen dust
• Vasomotar rhinitis – Sneezing less but
blocking and running of nose. Cold
remains throughout the year

Treatment of Allergic Rhinitis
• Tab – Zyrtec – 10 mg OD (Cetrizine)
• or Tab – Lorfast – 10 mg OD (Loratidine)
• These are non-sedeting drugs.
• or Rhinocort Nasal Spray
• or Otrivin Nasal drops (spray)
• Nasivion Nasal drops / nasivion pediatric nasal
drop
• or Tab – Wysolone – 5 mg TDS x 5 days
(Prednisolone)
• Adv. – Skull Xray to rull out – DNS – Deviated
Nasal Septum & Sinusitis

2) Hoarsness of Voice
• Causes :
• 1) Infective Laryngitis
• 2) Traumatic (misuse or overuse of voice)
• 3) Malignancy

2) Hoarsness of Voice --
Treatment
• Advice :
• 1) No talking (whispering is more dangerous)
• 2) Steam inhalation (loose sticky secretion) Tr.
Benzoic or vicks
• Tab – Roxid – 150 mg – BD x 7 days
(Roxythromycein)
• Tab – Betnelan – TDS x 7 days
(Betamethasone)
• Tab – Gatri – 400 mg OD (Gattifloxacin)
• Stops smoking

Hoarsness of Voice
• Caution :
• If the patient is > 50 years old No URTI, no
overuse of voice, Hoarseness > 2 weeks
refer to ENT, before treatment for
laryngoscopy.

3) Acute Bronchitis
• Clinical Features
• 1) Complaining of fever :
• 2) Cough with expectorant
• 3) Retrosternal chest pain
• O/E (on examination) Few Rhonchi and
bilateral crepitations
• Adv – Bed rest and stop smoking
• Steam inhalation.

3) Acute Bronchitis-- Treatment
• Treatment :
• 1) Cap – Novamox (Amoxycillin) 500 mg
QID
• 2) Benadryl expectorant 1 TSF TDS (Anti
allergic)
• 3) Tab- Bromhexine 8 mg TDS (Mucolytic)
• 4) Tab- Combiflam – 1 TDS (paracetamol)
• If Dyspnoea -- Tab – Deriphylline 1 TDS
(Bronchodialator)

4) Chronic Bronchitis
• Complaining of – cough with expectoration
– at least 2 years
• O/E – Wide spread Rhonchi, basal
crepitations, prolonged expiration.
• Fever (only in exacerbation – attack)
• Adv – X-Ray
• If prominent broncho vascular makings,
which indicates chr. bronchitis

Chronic Bronchitis -- Treatment
• Adv – in acute exacerbation
• 1) Steam inhalation
• Tab – Bromhexine 8 mg TDS
• If Dyspnoea / Breathlessness then
• Tab – Asthalin (Salbutamol) 4 mg BDS
• Tab – Bricanyl 2.5 mg TDS (Terbutalyn)

Antibiotics useful in all diseases in
R.S.
• 1) Cap. Mox 500 mg TDS
• 2) Cap cephalexin 500 mg QID
• 3) Tab- Cefuroxime – 250 mg BD (Ceftum)
• 4) Tab – Levofloxacin – 500 mg OD (L – cin)
• 5) Tab – Azee – 500 mg OD (Azithromycin)
• 6) Tab – Bactim DS – 1 BD (very cheap
antibiotic)
• 7) Tab wysolone (prednisolone) 10 mg TDS if
bronchospasm persists.

Chronic Bronchitis -- Treatment
• After acute attack -- medicines to prevent
recurrence.
• 1) Tab Doxy – 1 --100 mg, 1OD (doxycycline)
• 1st – 5th day of each month
• 2) Cap. Novamox – 500 mg -- When the cough
becomes purulent, yellow / greenish immediate
start this tab 1 TDS.
• Adv – 1) Stop smoking completely
• 2) Avoid Irritants

5) Pneumonia
• C/O – High grade fever with chills.
• Cough with expectoration, unilateral chest
pain,
• Patient looks very toxic and ill
• O/E bronchial breathing, localized
crepitations, less air entry
• X-Ray -- White opaque patch.

DD of Broncho & Lobar Pneumonia
Broncho pneumonia Lobar pneumonia
1) Organisms Strepto haemolyticus Diplococcus pneumonia.
2) Age Extreme of age i.e. in
children and old people.
Young adult
3) Pathological lesion Both lungs diffused. Limited to right lower
lobe
4) Onset Insidious Acute
5) Toxemia More Less
6) Temp. Not so high but
remissions
High temp. & continued.

DD of Broncho & Lobar Pneumonia
Broncho pneumonia Lobar pneumonia
7) Signs Patchy and bilateral Unilateral, located to the
right lower lobe.
8) Course (Duration) More (15 – 1 month) 7 – 10 days.
9) X-Rays Diffused finding Opaque shadow at rt.
lower lobe.
10) Air entry Not specific Is less
11) Complications Common Rare
12) Treatment Antibiotics in hospital
i.e. through I/V
In G.P. – Antibiotics
gives

Pneumonia - Treatment
• Same antibiotics like the previous
diseases, but Tab Roxid – covers nearly
all the organism, responsible for
pneumonia

Pneumonia
• Caution – Pneumonia patient should be admitted in
following conditions
• 1) Age > 60 years
• 2) Co-existing illness – DM
• 3) High fever, dehydrated, toxic (Thready and feeble
pulse)
• I/V and antibiotics
• 4) X-Ray – Shows involvement of more than 1 lobe
(broncho-pneumonia)
• 5) If patient refuses or unable to take medicine orally.
• In addition to antibiotics also gives Tab-combiflam and
Benadryl expectorant.

Breathless / Dyspnoea
• 1) Respiratory causes : 80 %
• 2) Cardiac causes
• 3) Other
• 4) Psychological

1) Respiratory causes of
Dyspnoea
• a) Acute Asthma
• b) Acute exacerbation of COPD
(chr. bronchiatis)
• 3) Pneumonia
• 4) Massive pleural effusion
• Admit – If
• 1) Pneumothorax
• 2) Pulmonary embolism
• 3) Pulmonary oedema / cardiac asthma / CCF

2) Cardiac causes of Dyspnoea
• 2) Cardiac Causes :
• a) Acute LVF
• b) Valvular heart disease

3) Other causes of Dyspnoea
• a) Renal failure (Uremia – breathlessness
increases) Adv – Urea , Creatinine
• b) Diabetic ketoacidosis / Daibetic coma

6) Pulmonary TB
• Cardinal symptoms of T.B.
• 1) Persistent cough with expectoration of long
duration ( more than 3 weeks)
• 2) Recurrent respiratory infections are common.
• 3) Dyspnoea is generally not prominent at rest
but is more on exertion.
• 4) Cyanosis : Patients are called "blue bloaters
• 5) Features of right heart failure (Cor pulmonale)
are common.
• 6) Chest X-ray shows enlarged heart with
prominent vessels.

Treatment of T.B.
• A) Sputum positive – New Patient
• HRZE for 2 months
• HR x 4 months
• AKT 4 1 kit per day x 2 months & cap
Rcinex 100 x 4 months (Rifampicin)
• clinical, radiological and pathological
(sputum)

Treatment of T.B.
• B) Sputum negative – New pt.
• on clinical and radiological
• HRZ – 2 months
• HR – 4 months
• Rimactazid – Z 1 kit/day x 2 months
• Cap Rcinex 100 x 4 months.

Treatment of T.B.
Sr.
No
Drug Child
Dose(mg/kg
/day)
Adult
Dose
Side Effect
1 Isonex
(H)
10 to 20 300 MG Neuritis,Rash
2 Rifampicin
(R)
10 to 15 450 MG Hepatitis,
Rash, Red Urine
3 Pyrazinamide (Z) 20 to 30 1.5 gm Hepatitis,
Arthralgia

Treatment of T.B.
Sr.
No
Drug Child
Dose
(mg/kg/d
a)
Adult
Dose
Side Effect
4 Ethambutol
(E)
15 – 25 800
gm
Optic neuritis
– check
vision
5 Streptomycin
(S)
20 – 40 1 gm Autotoxicity
(irreversible)

Treatment of T.B.
• Adv :
• Avoid crowded places & House rest for
minimum 1 month.
• Restrict complete physical & mental
stress.
• Takes high protein diet, milk – 1 lit / day,
egg, meat and Tonic like Chavanprash
• Give supportive Ayurvedic treatment

DD of Bronchial & Cardiac Asthama
Bronchial Asthma Cardiac Asthma
1) Pathology Bronchospasm Pulmonary congestion
oedema.
2) Age Young Elderly (above 50-60
years)
3) Sex Both Male mostly
4) Past history Of Eczema, urticaria (allergy)
suseptibility to cold, allergy to
polon, groundnuts, eggs.
No history of allergy, very
few attacks, LVF, RVF
5) family history Other family members may
have similar disease.
Hypertension may run in
families
6) personal history Highly sensitive individual Nil

7) Onset Acute, usually in early hours
of morning or late hours of
night.
Acute usually at
midnight (very specific)
8) Symptoms a) Expiratory Dyspnoea
b) Expectoration – scanty &
mucoid
c) No palpation cough with
sticky mucus.
a) Both dyspnoea expi.
& inspiratory
b) Profuse and frothy
c) Palpatation present
d) lot of sputum

9) O/E in
examination
a) Expiratory wheez present
b) sweating absent. may be present
c) cyanosis absent
d) pulse rate may be high
e) BP normal or slightly more
systolic
f) Heart sounds are distant (normal)
a) Absent (basal crepts and
rate)
b) sweating present
c) Cyanosis present
d) Very high (may be pulsus
alterance)
e) BP usually high.
f) 3 heart sounds Gallop
rhythm may be present in
mitral area
10) Examination of
lungs
Plenty of wheezing bronchii. Plenty of Rales & basal
crepitus

11) Treatment Antiasthematic,
antiallergic,
bronchodialators –
Asthalin, inj – Adrenalin
S/C. I/V deriphylin, inj –
Amonophylin.
Inj – Lasix (diuretic)
I/V admit patient, inj
– Aminophylin
Diluted in glucose &
given very slowly
(for 10-15 min)
Adrenalin not gives
in

Bronchial Asthma
• 1) Asthlin inhaler (salbutamol) 2 puff
• 2) Inj – Deriphyllin – 2CC
• 3) or Inj. Alupent 2CC – IM/SC
(orciprenalin)
• 4) Inj – Salbutamol – 0.25 mg I/V slowly

Bronchial Asthma
• If patient is young
• 1) Isoprenalin autohalor – 2 puff
• 2) Inj – Adrenalin – 0.5 ml s/c

Bronchial Asthma
• If attack is severe
• Inj – Aminophyllin – 10ml -diluted in 25 %
dextrose 10 ml, I/V very slowly in 5 mins
• or Nebuliser – Asthalin or Ipratropium

Bronchial Asthma
• C) If still not relieved with Aminophyllin
• 1) Repeat inj. Aminophyllin
• 2) Inj. Efcorlin – 100 mg I/V
(Hydrocortisone – steroid) or inj. Decadron
(Dexamethasone)
• & O2 by nasal catheter.

The patient should be admitted if
• 1) Patient is too breathless, to talk
• 2) Pulse > 120/min
• 3) RR > 30/min in children / young and in
adult > 50/min.
• 4) Cyanosis present – central – tongue,
lips etc, peripheral – tips of fingures
• 5) Bradycardia, hypotension, exhaustion
• 6) Silent chest – due to complete broncho
spasm (no respiratory sounds)

Maintenance of
Bronchial Asthma
• A) Mild intermittent Asthma :
• Attack < one / week & mild
• Treatment
• 1) Asthalin – Inhalar – 2 puff stat. & then
BD
• 2) Tab – Asthalin 4 mg BD or
• Tab – Deriphyllin (Theophyllin) 1 TDS
• Tab – Bricanyl 5 mg BD (Terbutalin)

Maintenance of
Bronchial Asthma
• B) Mild Persistent Asthma :
• Attack > 2 times / week, but not daily.
• Treatment
• 1) Asthalin – inhaler 2-3 puff. if attack
occur
• 2) Beclate inhaler 500 mg BD to prevent
that attacks (Beclomethasone)

Maintenance of
Bronchial Asthma
• C) Severe Persistent Asthma
• Attack daily
• Treatment
• 1) Beclate – inhaler – 500 mg BD
• 2) Serobid inhaler – 1 puff BD
• 3) Asthalin – 2-3 puffs (SOS)
• Tab – Wysolone (Prednisolon) 5 mg TDS
(SOS)

Kindly Note
• It is proved that for the Asthmatic patient
duration is not important severity of attack
is important
• So there is change in the concept of
Status Asthamaticus

Bronchiectasis
• Permanent dialation of bronchioles
• Causes – Chr. respiratory diseases like chr.
Brochitis
• Symptoms
• Cough with expectoration –Related to change of
posture, hence prominent in early hours of
morning or while going to bed.
• Copious and purulent
• Rarely haemoptysis
• Chest pain recurrently, due to dry pleurisy.
• febrile episode (attack) due to sec. infection.

Bronchiectasis
• General symptoms:
• Malaise, loss of weight
• O/E -- Clubbing
• Impaired Resonance – Percussion -- dull note
• Vocal resonance decreases
• Basal – plenty of leathery rales
• X-Ray Chest (PA view) --- Thickening of basal
pleura.
• Bird’s nest – appearance of basal lung.

Bronchiectasis
• Treatment
• 1) Postural Drainage : in the morning
• 2) Bronchoscopic Aspiration
• 3) Antibiotics (Bed ridden pts. are kept
under antibiotic cover and surgical
invention is done when necessary )

Tropical Eosinophilia
• C/O Intractable cough – not responding to
routine treatment
• Adv – PBS – for absolute Eosinophil count
• IF Eosinophil is greater than 30 to 40 %

Tropical Eosinophilia
• Treatment :
• Tab- Hetrazan – 100 mg TDS x 1 month
• Diethyl carbamazin citrate
• Tab wysolone ---Tapering Dose
• 1 – 1 – 1 2 days
• 1 – 0 – 1 2 days
• 1 – 0 – 0 2 days and then stop
• Note that Antiepileptic, Antihypertensive and
steroids should not be suddenly stop.

Emphysema
• Definition :
• Over distension of alveoli with rupture at
some places – due to chr. bronchitis or
chronic bronchial asthma.
• Dyspnoea – exertional to begin with and
then at rest also. Aggravation from time to
time, due to repeated infections

Emphysema
• In advanced cases dyspnoea increases,
even after normal routine movements e.g.
after eating, talking, defecation.
• Cough with expectoration – due to
associated chr. bronchitis.
• Wheezing sound
• Gradual weakness and loss of weight

Emphysema
• Sign
• 1) RR increases
• 2) Central cyanosis (tongue bluish)
• 3) Decubitus (special gait) -- propped up and
stopping forward.
• 4) Inspection : Barrel shaped chest
• 5) At the line of diaphragmatic attachment,
varicose veins are prominent called as
• Emphysematous Girdle

Emphysema
• Papation – VF (Vocal fremitus) decreases
• Percussion – Hyper resonant note.
• Auscultation – Breath sounds are
diminished,
• vesicular with prolonged expiration, VR
decreases (vocal resonance)

Emphysema
• X-ray – Radio translucent – lung fields, low
and flat diaphragm, elongation of cardiac
shadow – ‘Tubular heart’
• Complications
• Right sided heart failure – chronic cor-
pulmonale“( In ECG – Tall P wave – P
pulmonale)

Emphysema
• Treatment
• 1) Breathing exercises.
• 2) Antibiotics to prevent sec. infection,
intermittent O2 for CCP : diuretics (Lasix)
salt less diet and digitalis in CCF (gives
strength to heart)

Good Experiences
• Anti Allergic –
• Tab Relent =cetrizine Hcl 5 mg+ Ambroxol
hcl 60 mg -- 1 Tab at night

Cough ( Kasa)
• Gojihvadi Kwatha 20 to 40 ml TDS
• Sitopaladi Churna 5 to 10 gm TDS
• Kantakaryavaleha 5 to 10 ml TDS

Expectorant ( Kapha Nissarana)
• Tankan Bhasma 500 mg to 1 gm TDS
• Talisadi Churna --- 3 to 5 gm TDS
• Vasavleha – 5 to 10 gm TDS

Bronchitis ( Svasanika shoth)
• Laghu malini vasant -- 2TDS
• Lavangadi Churna – Half tsf tds with
honey
• Chousashtha Pippali churna -- Half tsf tds
with honey

TB ( Rajayakshma)
• Raj mrigank ras – 250 mg TDS
• Suvarna malini vasant – 1 tab tds
• Shataputi Abhrak bhasma – 125 mg tds
• Mukta panchamruta – 250 mg tds
• Shilajitvadi Lauha – 500 mg tds

Common cold ( Pratisyaya)
• Hinguleshvara rasa 250 mg tds
• Panchakola churna half tsf tds with honey
• Nag guti ( very Hot) – Not for Pitta Prakruti
• Cap Nesolarin ( Phyto Pharma) – Nag guti
+ Sameerpannag – 1 cap BD

Sinusitis ( Peenas)
• Shadbindu oil 3 drops TDS
• Dashamula Rasayanam – 2 tsf tds

Powders to treat Respiratory
problems like Asthama,Cough
• 1) Sitopaladi (Piitaja Kasa)
• 2) Karpuradi ( Kaphaja Kasa)
• 3) Talisadi ( Vataj Kasa)
• 4) Chausastha Pimpali
• 5) Shrungyadi
• 6) Yashtimadhu
• 7) Katphaladi
• 8) Bhagottar

Ayurvedic Tablets for Respiratory Problems
• Cough --- Anandabhirav Kasa
• Cold,Cough,Br.Asthama – Lavangadi
vati,Naga guti,Chaturbhuja rasa,Shwas
kuthar
• Tuberculosis ( Rajayakshma) –
Shriphalakusum vati ,Vasanta Kalpa like
Suvarna malini vasant

Ayurvedic Medicines for Respiratory Problems
• Tubercular Lymphadenitis – Kanchanar Guggulu
• Tonic in diseases like Tuberculosis, Chronic cough,
Br.Asthama – Drakshasav
• Cough,Br.Asthama – Kanakasav,Vasakasav,Vasadi
kadha
• Allergy ,Chronic sinusitis – Bhallatakadi
Kadha,Bhallatakasav
• Respiratory problems ( Rasayan for RS) –
Chavanprash, Dhatri Rasayan, Amalaki Avaleha

Ayurvedic Jams for Respiratory Problems
• Cough or Haemoptysis – Vasa Avaleha,
Vasa Ghruta
• Chronic cough,Ch.Bronchitis –
Katakaryavleha
• Cough,Br.Asthama – Ardrakavleha

Ayurvedic Medicines for Cough
• Katphaladi or Karpuradi or Talisadi or Sitopaladi or
Dadimadi or Yashtimadhu or Shrungyadi Churna
• Lavangadi or Eladi or Sitopaladi Vati
• Drakshasav, Punarnavasav
• Agastya Hartaki avaleh,Ardrakav leh (Aalepak)
,Kantakaryav leh, Chavanprash,Vasav leh,
• Vasa Ghruta, Lakshadi Tail,
• Kasis bhasma, Lokanath ras, Shrunga bhasma

Ayurvedic Medicines for
Bronchial Asthama
• Karpuradi or Dadimashtak, Pippalyadi or
Yashtimadhu, Samsharkar chuna, Chausashta
Pippali
• Bruhatvat chintamani, Suvarna malini vasant
• Kanakasav,Draksav,Dashamularishta
• Swaskuthar

Ayurvedic Medicines for
Bronchial Asthama
• Ardrakav leh, Chavanprash,
• Dadimvleh, Dhatri rasayan, Lashun pak,
Vasavleh,
• Narayan tail
• Abhrak bhasma, Manikya ras, Shrunga
bhasma, Makardhwaja, Mallasindur,
Rasaparpati,Rasa sindur, Loknath ras,
Sameerpannag

Ayurved for General Practioner
• Very very popular
Book in Medical
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• 100 common
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Treatments

Clinical Examination
• Systemic Examination
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• Ayurvedic Srotas
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Echo

Notes on Medicine Part 1
• Very very useful Book
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• Guidelines with
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urvedic & Modern
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Fever,Pain in
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Best Book for
Medical Students & Practioners

Preventive Cardiology
& Ayurvedic Management
• Best Book for GP
• All cardiac problems
like
Hypertention,CCF,
Angina,Myocardial
Infarct are discussed
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Management
Contact -922 68 10 630

Digestive Problems
& Ayurvedic Management
• All Digestive
problems like
Acidity,Pain in
abdomen,
• Constipation ,colitis
are discussed with
Ayurvedic
Management
Contact -922 68 10 630

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Ayurvedic Management
• All Gynaecological
problems like Heavy
bleeding,White
discharge,Infertility,ca
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Contact -922 68 10 630

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Ayurvedic Management
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• All Neurological
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Contact -922 68 10 630

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& Nutrition
• Dietary Advice
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,Dietary prescriptions
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• Contact -922 68 10
630

Health Tips for 365 Days
• This Book is very
useful from Common
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• It covers all imp
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• Open as per date &
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one page only

Prof.Dr.Deshpande’s
Popular Links on Internet
• Just Start Internet on Desk top or Lap top
or on your mobile . Copy Following Link &
Paste as Web address –URL
• http://www.youtube.com/user/deshpande1
959
• http://www.slideshare.net/rajendra9a/
• http://www.mixcloud.com/jamdadey/

Prof.Dr.Deshpande’s
Popular Links on Internet
• Just Start Internet on Desk top or Lap top
or on your mobile . Copy Following Link &
Paste as Web address –URL
• http://professordeshpande.blogspot.in
• http://professordrdeshpande.blogspot.in/
• http://www.mixcloud.com/rajendra-
deshpande
• https://soundcloud.com/professor-
deshpande

Prof.Dr.R.R.Deshpande
• Sharing of Knowledge
• FOR
• Propagating Ayurved
8/8/2015 110Prof.Dr.R.R.Deshpande

Respiratory system Problems in GP

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