ANAND HOMOEOPATHIC MEDICAL COLLEGE & RESEARCH INSTITUTE

ANAND HOSPITAL
2018 - 19

ASSIGNMENT ON
RESPIRATORY DISORDERS AND ITS HOMOEOPATHIC TREATMENT

Under Guidance from Dr. Rushika Navinkumar Chahuan

& Submitted to: Roll no.: 60
Dr. Anshul Shah Batch: 2018 - 19
R.M.O.

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NO. NAME OF DISEASE PAGE NO.

INTRODUCTION 3
LUNG DISEASE AFFECTING THE AIRWAY
1. ASTHMA 4
2. COPD 10
3. EMPHYSEMA 17
4. BRONCHITIS 24
5. BRONCHIECTASIS 31
LUNG DISEASE AFFECTING AIR SAC
6. PNEUMONIA 36
7. PULMONARY TUBERCULOSIS 43
8. LUNG CANCER 48
9. PNEUMOCONIOSIS 54
LUNG DISEASE AFFECTING OF PLEURA
10. PLEURISY 58
11. PLEURAL EFFUSION 62

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ANATOMY OF RESPIRATORY SYSTEM

Respiratory system is divided into 2 parts

 1 Upper respiratory tract
 2 Lower respiratory tract

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4
 PHYSIOLOGY

The respiratory system, which includes air passages, pulmonary vessels, the lungs,
and breathing muscles, aids the body in the exchange of gases between the air and
blood, and between the blood and the body’s billions of cells. Most of the organs of
the respiratory system help to distribute air, but only the tiny, grape-like alveoli and
the alveolar ducts are responsible for actual gas exchange.

In addition to air distribution and gas exchange, the respiratory system filters, warms,
and humidifies the air you breathe. Organs in the respiratory system also play a role in
speech and the sense of smell.

The respiratory system also helps the body maintain homeostasis, or balance among
the many elements of the body’s internal environment.

The respiratory system is divided into two main components:

Upper respiratory tract: Composed of the nose, the pharynx, and the larynx,
the organs of the upper respiratory tract are located outside the chest cavity.

 Nasal cavity: Inside the nose, the sticky mucous membrane lining the nasal cavity
traps dust particles, and tiny hairs called cilia help move them to the nose to be
sneezed or blown out.
 Sinuses: These air-filled spaces alongside the nose help make the skull lighter.
 Pharynx: Both food and air pass through the pharynx before reaching their
appropriate destinations. The pharynx also plays a role in speech.
 Larynx: The larynx is essential to human speech.

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Lower respiratory tract: Composed of the trachea, the lungs, and all segments
of the bronchial tree (including the alveoli), the organs of the lower respiratory tract
are located inside the chest cavity.

 Trachea: Located just below the larynx, the trachea is the main airway to the
lungs.
 Lungs: Together the lungs form one of the body’s largest organs. They’re
responsible for providing oxygen to capillaries and exhaling carbon dioxide.
 Bronchi: The bronchi branch from the trachea into each lung and create the
network of intricate passages that supply the lungs with air.
 Diaphragm: The diaphragm is the main respiratory muscle that contracts and
relaxes to allow air into the lungs.

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DISEASES OF UPPER RESPIRATORY TRACT

Common Cold:
Introduction:

The common cold is a frequent, recurrent, acute upper respiratory tract infection
affecting every age and race. It is a benign, self-limiting viral infection. The symptoms
are stuffy and/or runny nose, sneezing, cough, sore throat, and sometimes, mild fever
with generalized aches and pains. Although not a serious condition, colds have a
substantial impact on time lost from work and school, general practitioner consultations
and money spent on drugs - both prescription and over-the-counter.

Etiopathogenesis:

The etiological agents are viral. More than 200 different viruses are known to cause the
symptoms of the common cold. The most frequent viruses associated with respiratory
infections are human rhinoviruses (HRV). Although the majority of HRV infections are
mild and self-limited, HRV is an important cause of respiratory disease across all age
groups. Recent studies have established the importance of HRV in predisposing to or
causing otitis media, sinusitis and exacerbations of asthma, as well as other lower
respiratory tract disorders. Among elderly people, infants and immunocompromised

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hosts HRV infections are often associated with lower respiratory tract morbidity and
rarely mortality. However, the high incidence of HRV infections and their frequent
association with upper and lower respiratory tract complications highlight the need for
more effective means of prevention and treatment.
Other viruses responsible for more severe illnesses cause approximately 10 to 15
percent of adult colds include: Coronaviruses, adenoviruses, coxsackieviruses,
echoviruses, orthomyxoviruses (including influenza A and B viruses), paramyxoviruses
(including several parainfluenza viruses), respiratory syncytial virus and enteroviruses.

Viruses cause infection by overcoming the body's complex defense system: The body's
first line of defense is mucus, produced by the membranes in the nose and throat.
Mucus traps the material we inhale: pollen, dust, bacteria and viruses. When a virus
penetrates the mucus and enters a cell, it commandeers the protein-making machinery
to manufacture new viruses, which, in turn, attack surrounding cells.

Symptoms:

Cold symptoms are probably the result of the body's immune response to the viral
invasion. Virus-infected cells in the nose send out signals that recruit specialized white
blood cells to the site of the infection. In turn, these cells emit a range of immune

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system chemicals known as kinins (pro-inflammatory chemokines and cytokines).
These chemicals probably lead to the symptoms of the common cold by causing
swelling and inflammation of the nasal membranes, leakage of proteins and fluid from
capillaries and lymph vessels, and the increased production of mucus.
This results in sneezing, nasal congestion and swelling of the sinus membranes that
result in obstruction of nasal breathing. Post- nasal drip is the likely cause of the
irritating cough typical of colds. The mild fever and aches reflect a generalized response
to the viral infection.

Symptoms of the common cold usually begin two to three days after infection. Fever is
usually slight but can climb to 102o F in infants and young children. Cold symptoms can
last from 2 to 14 days, but two-thirds of people recover in a week. If symptoms occur
often or last much longer than two weeks, they may be the result of an allergy rather
than a cold.

Complications:

Colds occasionally can lead to secondary bacterial infections of the middle ear or
sinuses. High fever, significantly swollen glands including the tonsils, severe facial pain,
and a cough that produces mucus, may indicate a complication or more serious illness
requiring a doctor's attention.

The common cold is further complicated in those with a history of chronic respiratory
disorder such as asthma, chronic bronchitis, and respiratory complications associated
with smoking. Experimental rhinovirus infections in patients with asthma demonstrate
features of exacerbation, such as lower airway symptoms, variable airways obstruction,
and bronchial hyper-responsiveness. It has been proved by studies that these same
viruses have been found to initiate the same inflammatory processes as seen and
characterized in the asthmatic patient. This has clear implications for therapy of
asthmatic patients.

Conservative Management:
Most people recover on their own within two weeks. Over-the-counter products and
home remedies can help control symptoms.

Rest – Get plenty of rest. Give your body a chance to overcome the symptoms. Stay at
home as others can be easily infected.

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..
Fluids – Drink plenty of fluids so you do not get dehydrated.

Self-care: Menthol, Nasal washing, and steam inhalation

Medications:
Anticold
Antihistamine,
Cough suppressants,
Decongestant,
Analgesic,
Nonsteroidal anti-inflammatory drug,

New therapeutic interventions for upper respiratory tract infections need to be

developed based on the increasing patho-physiological knowledge about the role of
viruses and the antiviral immune response in common respiratory infection.

Prevention:
Stay home and do not go to work when you are sick.

If you have to go out wear a mask and avoid contact with infants, young children and
elderly people.

Use tissues whenever you cough and sneeze.

Wash your hands after coughing and sneezing, this is most important as the virus can
be transferred to others by direct contact.

Flu (Influenza)
Introduction:
The flu is similar to cold in that the patient may feel sore throat, muscle aches, runny
nose, cough, headache, and fever - except the flu comes on much more aggressively
and suddenly. If there is a fever, it will usually be higher and last longer with the flu than
with a cold. The flu is a very common illness. Attack rates in children range from 10% to

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40% a year. Children are more susceptible than adults. Morbidity occurs in adults 75
years and older, but rarely in the very young. Concurrent illness in elderly adults is
potentially dangerous. Both sexes are equally susceptible.

Etiology:
Influenza, an acute contagious respiratory infection caused by orthomyxoviruses
A, B, and C occurs in local outbreaks, epidemics and pandemics.
Influenza A is virulent, B is mild, and C is nonvirulent.

Pathogenesis:
 By airborne respiratory droplets (coughs or sneezes).
 By skin-to-skin contact (handshakes or hugs).
 By saliva (kissing or shared drinks).
 By touching a contaminated surface (blanket or doorknob).

Types:
• Type A: the most common.

• Type B: like Type A, it occurs every year. Influenza B outbreaks are generally
less extensive and are associated with less severe disease than those
associated with the influenza A virus.

• Type C: it spreads rapidly through a population. It tends to occur every two to

three years.

Types A and B change slightly from year to year and is considered a mutating illnesses.
The vaccines developed during the fall of one year don't work the next year.

The flu virus can survive for up to three days on its own, outside the body and can be
transmitted by air or through human contact. Once contracted, the virus incubates for 18
to 72 hours.

Symptoms:

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It typically comes on aggressively, with a fever of 102°F to 106° F. Because the root of
the virus is seated at the mucous membranes of the upper respiratory system, distress
symptoms are usually felt from this area and can include the following:

• Sore throat

• Dry cough

• Runny nose

• Sneezing

• Achy muscles, frontal headache, and watery, irritated eyes.

Though flu symptoms generally run for about three to four days, one may continue to
feel tired and run down for up to several weeks later.

Complications:
The flu can bring on secondary bacterial and viral infections like pneumonia, bronchitis,
acute sinusitis and middle-ear infections.

Conservative Management:
Bed rest: Reducing activity for a short period of time to promote healing.
Throat lozenge: Soothes sore throats.
Fluid intake: Replenishes water and nutrients in the body.

Medical Treatment:
Antiviral drugs: oseltamivir phosphate (Tamiflu), zanamivir, peramivir
Antihistamine,
Cough suppressants,
Decongestant,
Analgesic,
Nonsteroidal anti-inflammatory drug,

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Prevention:
“Trivalent” vaccines are made to protect against three flu viruses; influenza A: H1N1 & H3N2
virus, and influenza B virus.

Cover your nose and mouth with a tissue when you cough or sneeze. After using a
tissue, throw it in the trash and wash your hands.

Wash your hands often with soap and water or sanitizer.

Avoid touching your eyes, nose and mouth. Germs spread this way.

Clean and disinfect surfaces and objects that may be contaminated with germs like flu.

Allergic Rhinitis (Hay Fever)

Introduction:
Allergic rhinitis is the most common allergic disorder all over the world.
Allergic rhinitis, also known as Seasonal Allergy, is a type of inflammation in the nose which
occurs when the immune system overreacts to allergens in the air.

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Etiology:
An allergen is something that triggers an allergy. When a person with allergic rhinitis
breathes in an allergen such as pollen, mold, animal dander, or dust, the body releases
chemicals that cause allergy symptoms.

Hay fever involves an allergic reaction to pollen.

Plants that cause hay fever are trees, grasses, and weeds. Their pollen is carried by the
wind. (Flower pollen is carried by insects and does not cause hay fever.) Types of
plants that cause hay fever vary from person to person and from area to area. Hot, dry,
windy days are more likely to have a lot of pollen in the air.

Pathogenesis:
Allergen induces Th2 lymphocyte proliferation in persons with allergies with the release
of their characteristic combination of cytokines including IL-3, IL-4, IL-5, IL-9, IL-10, and
IL-13. These substances promote IgE and mast cell production. Mucosal mast cells that
produce IL-4, IL-5, IL-6, and tryptase proliferate in the allergic epithelium. Inflammatory
mediators and cytokines upregulate endothelial cell adhesion markers, such as vascular

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cell adhesion molecule-1. Chemoattractants, including eotaxin, IL-5, and RANTES, lead
to characteristic infiltration by eosinophils, basophils, Th2 lymphocytes, and mast cells
in chronic allergic rhinitis.

Symptoms:
Nasal: congestion, loss of smell, redness, runny nose, post-nasal drip, sneezing, or
stuffy nose, nasal pruritis, bilateral nasal obstruction
Eyes: itchiness, puffy eyes, redness, or watery eyes, irritation, lacrimation
Associated symptom: asthma and atopic dermatitis.

Conservative Management & Prevention:

Avoid allergen and Nasal washing

Medical Treatment:
Steroid,
Antihistamine,
Decongestant,
Eye decongestant,
Bronchodilator,
Anti-inflammatory
SINUSITIS
Introduction:
Sinusitis is an inflammation or swelling of the tissue lining the sinuses. Healthy sinuses are
filled with air. But when they become blocked and filled with fluid, germs can grow and
cause an infection.

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 Etiology:
Sinusitis can stem from various factors, but it always results from fluid becoming
trapped in the sinuses. This fuels the growth of germs.

 Viruses: In adults, 90 percent cases of sinusitis result from a virus

 Bacteria: In adults, 1 case in 10 is caused by bacteria

 Pollutants: Chemicals or irritants in the air can trigger a buildup of mucus

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 Fungi: The sinuses either react to fungi in the air, as in allergic fungal sinusitis (AFS),
or they are invaded by fungi, as in chronic indolent sinusitis.

Pathogenesis:

Symptoms:
 Sinus pressure behind the eyes and the cheeks
 A runny, stuffy nose that lasts more than a week
 A worsening headache
 A fever
 Cough
 Bad breath
 Thick yellow or green mucus draining from your nose or down the back of your
throat (postnasal drip)

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  Fatigue
 Decreased sense of smell

Diagnosis:
 Nasal endoscopy. A thin, flexible tube (endoscope) with a fiber-optic light inserted
through your nose allows your doctor to see the inside of your sinuses. This also is
known as rhinoscopy.

 Imaging studies. Images taken using a CT scan or MRI can show details of your
sinuses and nasal area. These might pinpoint a deep inflammation or physical
obstruction that's difficult to detect using an endoscope.

 Nasal and sinus cultures. Cultures are generally unnecessary for diagnosing
chronic sinusitis. However, when the condition fails to respond to treatment or is
worsening, tissue cultures might help determine the cause, such as bacteria or
fungi.

 An allergy test. If your doctor suspects that the condition might be triggered by
allergies, he or she might recommend an allergy skin test. A skin test is safe and
quick and can help pinpoint the allergen that's responsible for your nasal flare-ups.

Conservative Management:
For most cases of sinusitis include rest and drinking enough water to thin the mucus.
Antibiotics are not recommended for most cases.
Breathing low-temperature steam such as from a hot shower or gargling can relieve
symptoms

MEDICAL TREATMENT:
Decongestant, Antibiotics, Antihistamine, Nonsteroidal anti-inflammatory drug, Topical
nasal corticosteroids, Nasal saline washes

SURGERY:

Functional endoscopic sinus surgery (FESS)

Image-guided surgery
Caldwell-Luc operation

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 TONSILLITIS

INTRODUCTION:
An inflammation of the two oval-shaped pads of tissue at the back of the throat.

Tonsils are situated at the back of the throat. They are collections of lymphoid tissue
that form part of the immune system.

Although uncomfortable and unpleasant, the condition is rarely a major health concern.
The vast majority of people, whether given medication or not, will fully recover from
tonsillitis within a matter of days. Most symptoms will resolve within 7 to 10 days.

ETIOLOGY:
Bacterial cause:
 Streptococcus (Group A beta-hemolytic streptococci) &
 Staphylococcus bacteria.

Viral cause:

 Adenoviruses
 Influenza virus
 Epstein-Barr virus
 Parainfluenza viruses

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  Enteroviruses
 Herpes simplex virus

SYMPTOMS:
 Red, swollen tonsils

 White or yellow coating or patches on the tonsils

 Sore throat

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  Difficult or painful swallowing

 Fever

 Enlarged, tender glands (lymph nodes) in the neck

 A scratchy, muffled or throaty voice

 Bad breath

 Stiff neck

 Headache

Complications:
 Chronic tonsillitis – infection of the tonsils which does not clear up. The person
may go on feeling unwell and tired
 Secondary infections – the infection can spread to the person’s nose, sinuses or
ears
 Glue ear (otitis media) in children – the adenoids are part of the same group of
lymph nodes as tonsils. When the adenoids swell up (usually when the tonsils are
also large), they can block the Eustachian tube, which goes from the back of the
throat to the middle ear. This is the thin tube that you push air along when you
‘pop’ your ear. If this tube stays blocked most of the time, sticky fluid forms in the
middle ear which interferes with hearing.
 Quinsy – if the infection spreads into the tissue around the tonsils, an abscess can
form in the throat, also known as a peri-tonsillar abscess. This causes severe pain
and can interfere with swallowing and even breathing.

CONSERVATIVE MANAGEMENT:
 Gets a lot of rest
 Drinks plenty of fluids
 Tries eating soft foods if it hurts to swallow
 Tries eating warm liquids or cold foods like popsicles to soothe the throat
 Isn't around cigarette smoke or do anything else that could irritate the throat
 Sleeps in a room with a humidifier

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 Gargles with saltwater
 Sucks on a lozenge

MEDICAL TREATMENT:
 Paracetamol (acetaminophen) and ibuprofen
 Warm salt water gargle
 Antibiotics
 Analgesic
 Nonsteroidal anti-inflammatory drug (NSAID)
 Corticosteroids
 Surgery: Tonsillectomy

PHYARNGITIS: (Sore Throat)

Introduction:
Pain or irritation in the throat that can occur with or without swallowing, often
accompanies infections, such as a cold or flu.
Pharyngitis is inflammation of the pharynx, which is in the back of the throat. It’s most
often referred to simply as “sore throat.” Pharyngitis can also cause scratchiness in the
throat and difficulty swallowing.

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 Etiology:

Symptoms:

 Sore throat
 Pain or difficulty when swallowing or talking
 Swollen, sore glands in the neck or throat
 Red throat and red, swollen tonsils
 A hoarse voice
 White or grey patches on the back of the throat

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Diagnosis:
 Absence of a cough
 Swollen and tender cervical lymph nodes
 Temperature more than 38.0 °C (100.4 °F)
 Tonsillar exudate or swelling
 Age less than 15 (a point is subtracted if age is more than 44)

COMPLICATIONS:
Sinusitis, acute otitis media

Conservative Management:
Rest, oral fluids, and salt-water gargling (for soothing effect) are the main supportive
measures in patients with viral pharyngitis.
Analgesics and antipyretics may be used for relief of pain or pyrexia. Acetaminophen is
the drug of choice.

Medical Treatment:
Oral antibiotics like penicillin, amoxicillin, cephalexin or azithromycin are commonly
used.
Other medicines such as acetaminophen or ibuprofen can help with pain and fever.

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 LARYNGITIS:

INTRODUCTION:
Laryngitis is an inflammation of your voice box (larynx) from overuse, irritation or
infection. Inside the larynx are your vocal cords — two folds of mucous membrane
covering muscle and cartilage.

ETIOLOGY:
Acute laryngitis

Most cases of laryngitis are temporary and improve after the underlying cause gets
better. Causes of acute laryngitis include:

 Viral infections similar to those that cause a cold

 Vocal strain, caused by yelling or overusing your voice

 Bacterial infections, such as diphtheria, although this is rare, in large part due to
increasing rates of vaccination
Chronic laryngitis

Laryngitis that lasts longer than three weeks is known as chronic laryngitis. This type of
laryngitis is generally caused by exposure to irritants over time. Chronic laryngitis can

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cause vocal cord strain and injuries or growths on the vocal cords (polyps or nodules).
These injuries can be caused by:

 Inhaled irritants, such as chemical fumes, allergens or smoke

 Acid reflux, also called gastroesophageal reflux disease (GERD)

 Chronic sinusitis

 Excessive alcohol use

 Habitual overuse of your voice (such as with singers or cheerleaders)

 Smoking

SYMPTOMS:

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COMPLICATIONS:
Infection may spread to other parts of the respiratory tract.
Formation of nodules or polyps on the vocal cords.
Pneumonia, chronic bronchitis, and vocal cord paralysis.

CONSERVATION & PREVENTION:

 Don't smoke, and avoid secondhand smoke. Smoke dries your throat and irritates your
vocal cords.

 Limit alcohol and caffeine. These cause you to lose total body water.

 Drink plenty of water. Fluids help keep the mucus in your throat thin and easy to clear.

 Avoid eating spicy foods. Spicy foods can cause stomach acid to move into the throat or
esophagus, causing heartburn or gastroesophageal reflux disease (GERD).

 Include whole grains, fruits and vegetables in your diet. These foods contain vitamins
A, E and C, and help keep the mucous membranes that line the throat healthy.

 Avoid clearing your throat. This does more harm than good, because it causes an
abnormal vibration of your vocal cords and can increase swelling. Clearing your throat also
causes your throat to secrete more mucus and feel more irritated, making you want to
clear your throat again.

 Avoid upper respiratory infections. Wash your hands often, and avoid contact with
people who have upper respiratory infections such as colds.

MEDICAL TREATMENT:
Antacid: Counteracts the effects of stomach acid.

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Nonsteroidal anti-inflammatory drug: Relieves pain, decreases inflammation and
reduces fever.
Analgesic: Relieves pain.
Proton-pump inhibitor: Decreases acid release in the stomach.

EPIGLOSSITIS:
INTRODUCTION:
Epiglottitis is inflammation of the epiglottis—the flap at the base of the tongue that
keeps food from going into the trachea (windpipe).
Epiglottitis is commonly caused by an infection. The resulting inflammation causes
swelling, which blocks air to the lungs.

ETIOLOGY:
Epiglottitis is typically due to a bacterial infection of the epiglottis. While it historically
was most often caused by Haemophilus influenzae type B with immunization this is no
longer the case.
Bacteria that are now typically involved are Streptococcus pneumoniae, Streptococcus
pyogenes, or Staphylococcus aureus.
Other possible causes include burns and trauma to the area.[1] Epiglottitis has been
linked to crack cocaine usage.

SYMPTOMS:
Shortness of breath, difficulty swallowing and sore throat.
Trouble swallowing which can result in drooling, changes to the voice, fever, and an
increased breathing rate.
Fever, throat pain, difficulty in swallowing, drooling, hoarseness of voice, and stridor.

DIAGNOSIS:

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X-ray & Direct inspection using a laryngoscope, although this may provoke
airway spasm. If epiglottitis is suspected, attempts to visualize the epiglottis using
a tongue depressor are discouraged for this reason; therefore, diagnosis is made on
basis of indirect fiber optic laryngoscopy carried out in controlled environment like an
operating room.

PREVENTION:
An effective vaccine, the Hib vaccine, has been available since the 1980s.
The antibiotic rifampicin may also be used to prevent the disease among those who
have been exposed to the disease and are at high risk.

MANAGEMENT:
Antibiotics
Stops the growth of or kills bacteria.

Airway management
A breathing tube and ventilator may be required in severe cases.
Clearing a blocked airway of food, foreign objects, fluid and other obstructions. A top
priority in emergency situations.

IV fluids

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 Delivering fluids, medication or blood directly into a vein.

STRIDOR:

INTRODUCTION:
Stridor (Latin for "creaking or grating noise") is a high-pitched breath sound resulting
from turbulent air flow in the larynx or lower in the bronchial tree. Stridor is a physical
sign which is caused by a narrowed or obstructed airway. It can be inspiratory,
expiratory or biphasic, although it is usually heard during inspiration. Inspiratory stridor
often occurs in children with croup. It may be indicative of serious airway obstruction
from severe conditions such as epiglottitis, a foreign body lodged in the airway, or a
laryngeal tumor

ETIOLOGY:
 Inhaling a foreign object, smoke

 laryngitis or swelling and irritation of the voice box

 swollen tonsils

 an injury to the airways

 an allergic reaction

 swelling of the face or neck

 long-term use of a breathing tube

 cancer of the vocal cords

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Symptoms:

TREATMENT:
 Oxygen (humidified if possible)
 Dexamethasone oral (unless swallowing problems then IV) 8mg twice daily (morning
and lunchtime)
 Add in gastroprotection if appropriate (e.g. omeprazole oral 20mg once daily or
lansoprazole 30mg once daily if no contraindications).
 Nebulised salbutamol 5mg when required
 If severe and not improving on conservative management may need to consider:
o Tracheostomy if upper airway obstruction – discuss with on call ENT
o Nebulised adrenaline – discuss with senior doctor used to giving this e.g. ITU
 Radiotherapy if appropriate – discuss with on-call clinical oncologist
 Laser / stenting for tracheal obstruction - discuss with local Respiratory team

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 Consider Heliox 80:20 if available (helium oxygen mix which is less viscous than air
and easier to inhale past obstruction).

LUNG DISORDERS
=>Introduction:
Respiratory disease is a medical term that encompasses pathological conditions
affecting the organs and tissues that make gas exchange possible in higher organisms, and
includes conditions of the upper respiratory tract, trachea, bronchi, bronchioles, alveoli, pleura
and pleural cavity, and the nerves and muscles of breathing. Respiratory diseases range from
mild and self-limiting, such as the common cold, to life-threatening entities like bacterial
pneumonia, pulmonary embolism, acute asthma and lung cancer.
The study of respiratory disease is known as pulmonology. A doctor who specializes
in respiratory disease is known as a pulmonologist, a chest medicine specialist, a respiratory
medicine specialist, a respirologist or a thoracic medicine specialist.
Respiratory diseases can be classified in many different ways, including by the organ
or tissue involved, by the type and pattern of associated signs and symptoms, or by the cause
(etiology) of the disease.

COMMON LUNG DISORDERS

 LUNG DISEASE AFFECTING THE AIRWAY
- ASTHMA
- COPD
- CHRONIC BRONCHITIS
- EMPHYSEMA
- BRONCHIECTASIS

 LUNG DISEASE AFFECTING THE AIR SACS

- PNEUMONIA
- TUBERCULOSIS

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 - LUNG CANCER
- PNEUMOCONIOSIS

 DISEASE AFFECTING PLEURA

- PLEURISY
- PLEURAL EFFUSION

LUNG DISEASE AFFECTING THE AIRWAY

(1) ASTHMA

The word ‘asthma‘ is derived from the Greek meaning ‘panting’ or ‘labored
breathing’. Asthma is a condition characterized by a paroxysmal wheezing respiration dyspnea
(difficulty in breathing), mainly expiratory.

=> CAUSES:
According to the etiology, bronchial asthma is divided in the following groups:

1. Allergic (extrinsic/ atopic) Asthma: This type of asthma usually starts in childhood and
is often preceded by eczema. But most of the young adults (<35 yrs.) developing asthma also fall
in this category. Genetic factors also play a significant role in this. In this type of asthma, the
allergen leads to production of excessive (IgE) immunoglobulins.

2. Infective or Intrinsic Asthma: This is not hereditary or allergic, but may be caused by, or
at least associated with upper respiratory tract or bronchial infection which is usually viral.

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3. Emotional Asthma: Psychological factors (like anxiety, emotional stress etc.) are often
considered to be the sole cause of some asthmatic attacks, but it is still not certain whether it
can be the sole cause or is only a precipitating factor.

4. Occupational asthma: This can occur in certain industries in which there is exposure to
metallic dusts (esp. platinum salts), biological detergents, toluene diisocyanate, polyurethane,
flour and dust from grains etc.
Whatever may be the cause, it ultimately leads to paroxysms of bronchial obstruction produced
by widespread bronchial spasm accentuated by plugging of the bronchi with excessive mucus.

=>Pathophysiology:
Asthma is the result of chronic inflammation of the conducting zone of the airways
(most especially the bronchi and bronchioles), which subsequently results in increased
contractibility of the surrounding smooth muscles. This among other factors leads to bouts of
narrowing of the airway and the classic symptoms of wheezing. The narrowing is typically
reversible with or without treatment.
Occasionally the airways themselves change. Typical changes in the airways include
an increase in eosinophils and thickening of the lamina reticularis. Chronically the airways'
smooth muscle may increase in size along with an increase in the numbers of mucous glands.
Other cell types involved include: T lymphocytes, macrophages, and neutrophils. There may also
be involvement of other components of the immune system including: cytokines, chemokines,
histamine, and leukotrienes among others.

=> SIGNS AND SYMPTOMS:

Asthma is characterized by recurrent episodes of wheezing, shortness of breath, chest
tightness, and coughing. Sputum may be produced from the lung by coughing but is often hard
to bring up. During recovery from an attack, it may appear pus-like due to high levels of white
blood cells called eosinophils. Symptoms are usually worse at night and in the early morning or
in response to exercise or cold air. Some people with asthma rarely experience symptoms, usually
in response to triggers, whereas others may have marked and persistent symptoms.
Associated conditions
A number of other health conditions occur more frequently in those with asthma,
including gastro-esophageal reflux disease (GERD), rhinosinusitis, and obstructive sleep apnea.
Psychological disorders are also more common, with anxiety disorders occurring in between 16–
52% and mood disorders in 14–41%. However, it is not known if asthma causes psychological
problems or if psychological problems lead to asthma. Those with asthma, especially if it is poorly
controlled, are at high risk for radiocontrast reactions.
- Recurrent episode of paroxysmal dyspnea (difficulty in breathing)
34
 - The breathing is labored, with a wheezing sound, mainly on expiration.

-Asthma attacks often occur in the early hours of morning (when there is no
immediate precipitating cause). During the attack patients often prefers to sit then lie down.

=> DIAGNOSIS:
Diagnosis can usually be made clinically by a competent doctor. Allergen sensitivity tests, X-ray,
spirometry, sputum and blood tests etc. may be of use in finding the cause and severity of the
condition.
Asthma – WHAT TO DIFFERENTIATE FROM?
•Bronchitis
•Cardiac asthma
•Renal asthma
•Isolated attacks of non-paroxysmal dyspnea.

=> Complication:
- Apart from chronicity, usually no complications.

- Pneumothorax, emphysema, or areas of consolidation or pulmonary collapse may occur in

very advanced cases.

=> Asthma Treatment:

 Lifestyle modification
Avoidance of triggers is a key component of improving control and preventing attacks.
The most common triggers include allergens, smoke (tobacco and other), air pollution, non-
selective beta-blockers, and sulfite-containing foods. Cigarette smoking and second-hand smoke
(passive smoke) may reduce the effectiveness of medications such as corticosteroids. Laws that
limit smoking decrease the number of people hospitalized for asthma. Dust mite control
measures, including air filtration, chemicals to kill mites, vacuuming, mattress covers and others
methods had no effect on asthma symptoms. Overall, exercise is beneficial in people with stable
asthma. Yoga could provide small improvements in quality of life and symptoms in people with
asthma.

 Medications

35
 Medications used to treat asthma are divided into two general classes: quick-relief
medications used to treat acute symptoms; and long-term control medications used to prevent
further exacerbation. Antibiotics are generally not needed for sudden worsening of symptoms.

Homoeopathic treatment for asthma

General Approach:
Homeopathy is a system of medicine which tries to ‘cure’ this disease, instead
of trying to provide symptomatic relief. While dealing with a case of asthma, a homeopath not
only records the symptoms of the disease but also studies the medical history, family history,
physical and psychological characteristics of a person. This helps to find the cause, the
precipitating factors, and the hereditary tendency etc. Of special interest to a homeopath is the
history of suppression of skin disease.
Homeopaths believe that when there is a tendency or predisposition for a
disease it first manifests on the less vital organs, towards the periphery (like skin). If this
manifestation is suppressed than the disease shifts inwards, towards the more vital organs (like
lungs, heart, brain etc.).
The fact that in children asthma is often preceded by eczema is observed by the
allopath’s also. This fact is written in all their textbooks of medicine. They say that children often
‘move-out’ of eczema and ‘move-into’ asthma. But they are unable to make a correlation.
Homeopaths believe that the suppression of eczema with topical preparations, does not cure the
disease/sensitivity of the person, it merely drives it inwards.
Now after ascertaining the symptoms and the cause, the homeopath tries to
find a medicine which matches the symptoms as well as the general characteristics of the person.
The medicine so selected is administered to the patient.
It is often (not necessarily) observed by homeopaths that when a right
medicine is given, the asthma disappears but the old eczema or skin rash (if it was there originally)
reappears for some time, before finally disappearing itself. This reappearance of old symptoms
is seen as a reversal of disease process and is considered a very good prognostic sign by
homeopaths.

36
 - Ipecac - Ars alb
- Nux vomica - Kali bich
- Nat sulph
(1) Ipecac :
This remedy is a close homoeopathic simile to asthma, especially to the spasmodic
variety where the symptoms are great weight and anxiety about the chest; sudden wheezing,
dyspnoea, threatening suffocation, aggravated by motion; the cough causes gagging and
vomiting.
The cough is constant, the chest seems full of phlegm, yet none is expectorated, and
the extremities are covered with cold perspiration. Lobelia is a remedy which one usually
classifies with Ipecac. It has the great oppression of the chest and a weak sensation in the chest
which seems to come from the epigastrium, where there is a feeling of a lump; there is nausea,
profuse salivation; the attack is preceded by a pricking sensation through the whole system. It is
most useful in bronchial and septic asthmas.
The breathing is exceedingly difficult, and is relieved by moving about. A pain
extending around the forehead from one temple to other and a pain in the back at the last dorsal
vertebra are also useful indications. Arsenicum is quite similar to Ipecac in asthma, and attacks
coming on after midnight lead to the use of this remedy. With Ipecac the expiration is especially
difficult; vomiting when it occurs is apt to relieve the attack.

(2) Arsenicum alb :

As stated above, Arsenicum has some similarity to Ipecac, but the time of attacks
is just after midnight. The patient has a great deal of anguish and restlessness; he cannot lie down
for fear of suffocation. There is anxiety and general sweat, and if the patient drowses off he is
awakened with burning pain and soreness in the chest.
It is especially the remedy if the disease be chronic and the dyspnoea habitual
and dry and the patient aged. Apis has a suffocative feeling, and the patient does not see how he
can get another breath, and the Bromine patient breathes very deeply as it seems as if he could
not get air enough into his lungs, while under Grindelia robusta the patient on falling asleep
ceases to breathe and awakes with a start. Grindelia has been found clinically to benefit humid
asthmas and acute catarrhal asthmas, and Halbert states that 5 or 10 drops of the tincture every
hour during the paroxysmal state will greatly palliate.
Probably in higher potencies it would act curatively for its symptomatology
represents the typical paroxysmal features of this disease. It has a peculiar symptom, a fear of
going to sleep on account of loss of breath which awakens him. Viscum album is also clinically
recommended. It has weakness of the respiratory and stertorous breathing. The asthma of

37
Arsenicum is accompanied by great debility and burning in the chest, and it follows Ipecac well,
and is especially useful in anemic persons. Baehr and Jousset place this remedy at the head of
our list for asthma.

(3) Nux vomica :

Nux vomica is a useful remedy when the asthmatic attacks are brought on by
gastric disturbances; simple spasmodic asthmas; there is some relief by belching, the patient
must loosen the clothing. It must also be thought of in those who drink much coffee or liquor.
Irritable bilious temperaments also correspond to the drug.
Zingiber is also a remedy for asthma of gastric origin, and the attacks come on
toward morning; the patient must sit up; no anxiety. A good symptom calling for Nux is a
constricted felling at the lower part the chest. Where there is much abdominal irritation present
with much flatulence, Lycopodium and Carbo vegetabilis should be thought of. Carbo vegetabilis
also corresponds to the asthma of the aged who are much debilitated; they are greatly oppressed
for breath and are relieved by belching wind.

(4) Kali bichromicum:

The potashes produce asthmatic condition, and under Kali bichromicum we find the
attacks coming on about three or four o’clock in the morning, compelling the patient to sit up to
breath; he sits up and bends forward which relives somewhat, as does also the expectoration of
stringy yellow mucus, which is characteristic of the remedy. It is similar to Arsenicum except for
this feature of tenacious mucus. Kali carbonicum has asthma worse towards morning, with a
feeling as if there were no air in the chest.

(5) Natrum sulph :

HYDROGENOID CONSTITUTION. All complaint are aggravated in damp wet weather.
sycotic asthma. there is difficulty in breathing occur. patient hold his chest with his hand. there
is desire to taking deep breathing. yellowish expectoration with difficulty in breathing. Ailments
due to damp basement,cellars.Aggravation in wet weather and relived in dry weather.

38
 (2) CHRONIC OBSTRUCTIVE PULMONARY DISEASE

COPD is the type of obstructive lung disease characterized by long term poor airflow.
The main symptoms are shortness of breath and sputum production. it is progressive disease.

=>Cause:
The latter represent the innate and adaptive immune responses to a lifetime of exposure
to noxious particles, fumes and gases, particularly cigarette smoke. All cigarette smokers have
inflammatory changes within their lungs, but those who develop COPD exhibit an enhanced or abnormal
inflammatory response may result in mucous hyper-secretion (chronic bronchitis), tissue destruction.

 Smoking:

The primary risk factor for COPD globally is tobacco smoking. Of those who
smoke about 20% will get COPD, and of those who are lifelong smokers about half will get COPD.
In the United States and United Kingdom, of those with COPD, 80–95% are either current smokers
or previously smoked. The likelihood of developing COPD increases with the total smoke

39
exposure. Additionally, women are more susceptible to the harmful effects of smoke than men.
In non-smokers, secondhand smoke is the cause of about 20% of cases.
Other types of smoke, such as marijuana, cigar, and water pipe smoke, also
confer a risk. Water pipe smoke appears to be as harmful as smoking cigarettes. Problems from
marijuana smoke may only be with heavy use. Women who smoke during pregnancy may
increase the risk of COPD in their child. For the same amount of cigarette smoking, women have
a higher risk of COPD than men.

 Air pollution
Poorly ventilated cooking fires, often fueled by coal or biomass fuels such as wood
and animal dung, lead to indoor air pollution and are one of the most common causes of COPD
in developing countries. These fires are a method of cooking and heating for nearly 3 billion
people with their health effects being greater among women due to more exposure. They are
used as the main source of energy in 80% of homes in India, China and sub-Saharan Africa.
People who live in large cities have a higher rate of COPD compared to people who
live in rural areas. While urban air pollution is a contributing factor in exacerbations, its overall
role as a cause of COPD is unclear. Areas with poor outdoor air quality, including that from
exhaust gas, generally have higher rates of COPD. The overall effect in relation to smoking,
however, is believed to be small.

 Occupational exposures
Intense and prolonged exposure to workplace dusts, chemicals and fumes increase
the risk of COPD in both smokers and nonsmokers. Workplace exposures are believed to be the
cause in 10–20% of cases. In the United States they are believed to be related to more than 30%
of cases among those who have never smoked and probably represent a greater risk in countries
without sufficient regulations.
A number of industries and sources have been implicated, including [8] high levels
of dust in coal mining, gold mining, and the cotton textile industry, occupations involving
cadmium and isocyanates, and fumes from welding.
Working in agriculture is also a risk. In some professions the risks have been
estimated as equivalent to that of one half to two packs of cigarettes a day. Silica dust exposure
can also lead to COPD, with the risk unrelated to that for silicosis. The negative effects of dust
exposure and cigarette smoke exposure appear to be additive or possibly more than additive.

 Genetics
Genetics play a role in the development of COPD. It is more common among
relatives of those with COPD who smoke than unrelated smokers. Currently, the only clearly
inherited risk factor is alpha 1-antitrypsin deficiency (AAT). This risk is particularly high if someone

40
deficient in alpha 1-antitrypsin also smokes. It is responsible for about 1–5% of cases and the
condition is present in about 3–4 in 10,000 people. Other genetic factors are being investigated,
of which there are likely to be many.

 Other
A number of other factors are less closely linked to COPD. The risk is greater in
those who are poor, although it is not clear if this is due to poverty itself or other risk factors
associated with poverty, such as air pollution and malnutrition. There is tentative evidence that
those with asthma and airway hyper reactivity are at increased risk of COPD. Birth factors such
as low birth weight may also play a role as do a number of infectious diseases including HIV/AIDS
and tuberculosis. Respiratory infections such as pneumonia do not appear to increase the risk of
COPD, at least in adults.

=> SYMPTOMS:
The most common symptoms seen in COPD are breathlessness, cough and fatigue.
There is no good correlation between lung function and symptoms of COPD, not even the
standardized scoring of breathlessness correlates well with FEV; the important message being
that a simple physiological measure can never substitute a symptom history

Wheezing
Wheezing is generally seen as an asthma symptom but frequently occurs in COPD as
well. However, nocturnal wheeze is uncommon in COPD and Suggests the presence of asthma
and/or heart failure.

Fatigue
Fatigue is frequently reported by COPD patients.

Other symptoms
Chest pain is a common complaint in COPD, mostly secondary to muscle pain.
However, it should be noted that ischemic heart disease is frequent in any population of heavy
smokers and COPD patients may be at particular risk.
Ankle swelling may result from immobility secondary to breathlessness or as result
of right heart failure. Anorexia and weight loss often occurs as the disease advances and should
be mirrored by measurements of body mass index (BMI) and body composition. Psychiatric
morbidity is high in COPD, reflecting the social isolation, the neurological effects of hypoxemia
and possibly the effects of systemic inflammation. Sleep quality is impaired in advanced disease
and this may contribute to neuropsychiatric comorbidity.

41
=>Diagnosis:
The diagnosis is largely made on the clinical grounds in patients who have smoked. It is
confirmed by demonstrating airflow obstruction that shows little day to day or diurnal variation
and minimal response to bronchodilators. Airflow obstruction can only be accurately showed by
spirometry rather than by measuring peak flow rates

Chest x-ray

Spirometry
Spirometry measures the amount of airflow obstruction present and is generally
carried out after the use of a bronchodilator, a medication to open up the airways. Two main
components are measured to make the diagnosis: the forced expiratory volume in one second
(FEV1), which is the greatest volume of air that can be breathed out in the first second of a breath,
and the forced vital capacity (FVC), which is the greatest volume of air that can be breathed out
in a single large breath. Normally, 75–80% of the FVC comes out in the first second and a
FEV1/FVC ratio of less than 70% in someone with symptoms of COPD defines a person as having
the disease. Based on these measurements, spirometry would lead to over-diagnosis of COPD in
the elderly. The National Institute for Health and Care Excellence criteria additionally require a
FEV1 of less than 80% of predicted.

42
 Evidence for using spirometry among those without symptoms in an effort to diagnose
the condition earlier is of uncertain effect and is therefore currently not recommended. A peak
expiratory flow (the maximum speed of expiration), commonly used in asthma, is not sufficient
for the diagnosis of COPD.

Other tests
A chest X-ray and complete blood count may be useful to exclude other conditions at the
time of diagnosis. Characteristic signs on X-ray are over expanded lungs, a flattened diaphragm,
increased retrosternal airspace, and bullae while it can help exclude other lung diseases, such as
pneumonia, pulmonary edema or a pneumothorax. A high-resolution computed tomography
scan of the chest may show the distribution of emphysema throughout the lungs and can also be
useful to exclude other lung diseases. Unless surgery is planned, however, this rarely affects
management. An analysis of arterial blood is used to determine the need for oxygen; this is
recommended in those with an FEV1 less than 35% predicted, those with a peripheral oxygen
saturation of less than 92% and those with symptoms of congestive heart failure.

=> Differential diagnosis:

COPD may need to be differentiated from other causes of shortness of breath such as
congestive heart failure, pulmonary embolism, pneumonia, or pneumothorax. Many people
with COPD mistakenly think they have asthma. The distinction between asthma and COPD is
made on the basis of the symptoms, smoking history, and whether airflow limitation is reversible
with bronchodilators at spirometry. Tuberculosis may also present with a chronic cough and
should be considered in locations where it is common. Less common conditions that may present
similarly include bronchopulmonary dysplasia and obliterate bronchiolitis. Chronic bronchitis
may occur with normal airflow and in this situation it is not classified as COPD considered for
testing.

=>Management:
There is no known cure for COPD, but the symptoms are treatable and its progression
can be delayed. The major goals of management are to reduce risk factors, manage stable COPD,
prevent and treat acute exacerbations, and manage associated illnesses. The only measures that
have been shown to reduce mortality are smoking cessation and supplemental oxygen. Stopping
smoking decreases the risk of death by 18%.
Other recommendations include influenza vaccination once a year, pneumococcal
vaccination once every 5 years, and reduction in exposure to environmental air pollution. In those
with advanced disease, palliative care may reduce symptoms, with morphine improving the
feelings of shortness of breath. Noninvasive ventilation may be used to support breathing.
Providing people with a personalized action plan, an educational session, and support for use of

43
their action plan in the event of an exacerbation, reduces the number of hospital visits and
encourages early treatment of exacerbations.

 Exercise
Pulmonary rehabilitation is a program of exercise, disease management and
counseling, coordinated to benefit the individual. In those who have had a recent exacerbation,
pulmonary rehabilitation appears to improve the overall quality of life and the ability to exercise.
It is not clear if pulmonary rehabilitation improves mortality rates or hospital re-admission rates.
Pulmonary rehabilitation has been shown to improve the sense of control a person has over their
disease, as well as their emotions.

The optimal exercise routine, use of non-invasive ventilation during exercise, and
intensity of exercise suggested for people with COPD, is unknown. Performing endurance arm
exercises improves arm movement for people with COPD, and may result in a small improvement
in breathlessness. Performing arm exercises alone does not appear to improve quality of life.
[9Breathing exercises in and of themselves appear to have a limited role.
Pursed lip breathing exercises may be useful. Tai Chi exercises appear to be safe to
practice for people with COPD, and may be beneficial for pulmonary function and pulmonary
capacity when compared to a regular treatment program. Tai Chi was not found to be more
effective than other exercise intervention programs.
Being either underweight or overweight can affect the symptoms, degree of disability
and prognosis of COPD. People with COPD who are underweight can improve their breathing
muscle strength by increasing their calorie intake. When combined with regular exercise or a
pulmonary rehabilitation program, this can lead to improvements in COPD symptoms.
Supplemental nutrition may be useful in those who are malnourished.

 Bronchodilator
 Corticosteroids

Homoeopathic treatment for COPD

- Antim tart
- Ammon carb
- Bromium
- Carbo veg

44
 - Chinium Ars
- Bryonia
- Rumex
(1) Antimonium-tart:
EXCESSIVE dyspnoea, must be supported in a sitting posture in bed; great rattling of
mucus in bronchial tubes, particularly just below the larynx; gasping for breath at the beginning
of every coughing spell; violent pains from chest to shoulder.

(2) Ammonium-carb:
Atony of bronchial tubes; copious accumulation of mucus in lungs, dilatation of
bronchial tubes and edema pulmonum; asthmatic oppression of breathing with stitches in chest,
(<) on physical effort or magic oppression of breathing with stitches in chest, (<) on physical effort
or when entering a warm room; cough continual, but raises nothing or only a when entering a
warm room; cough continual, but raises nothing or only a little with difficulty, (<) 3 to 4 A.M.,
with rattling of large bubbles in chest, feels faint from the effort to breathe; drowsy and cyanotic
from blood-poisoning by carbonic acid.

(3) Bromium:
After pneumonia, asthma, cough dry, whistling, tickling in larynx; gasping for breath
with wheezing and rattling high up and spasmodic closure of glottis; he cannot inspire deep
enough; pressure in stomach, must sit up in bed at night.

(4) Carbo veg:

Often after Ars: neglected chronic bronchitis. Great dyspnoea and anxiety, but no
restlessness; cough in violent spells; watery, profuse expectoration; breathing short, with cold
hands and feet; cold breath; blueness of skin, (>) from hard fanning; threatened paralysis of
ALVEOLI.

(5) Chinium Ars :

Regularly even forenoon at 9 A.M. attacks of suffocating spells in tuberculosis; limbs
icy cold; cold, clammy sweat all over; greatest anxiety and unquenchable thirst; must sit up, bent
forward if possible, at an open window.

(6) Bryonia:
A wonderful remedy in homeopathic treatment for COPD in patients who have dry
hacking cough with rust-colored sputum. Any slightest motion seems to increase the complaints.
Cough occurs immediately after entering a warm room.

45
(7) Rumex:
Useful in homeopathic treatment for COPD in patients who have dry teasing cough
initially, followed by stringy cough. Complaints increase on talking, by pressure and taking in cold
air.

(3) EMPHYSEMA

=>Introduction:
Emphysema is a chronic respiratory disease where there is over-inflation of the air
sacs (alveoli) in the lungs, causing a decrease in lung function, and often, breathlessness. Known
as PINK PUFFER.
Emphysema is a condition that forms part of chronic obstructive pulmonary disease
(COPD) and involves the enlargement of the air sacs in the lung.
The alveoli at the end of the bronchioles of the lung become enlarged because of the
breakdown of their walls. The fewer and larger damaged sacs that result mean there is a reduced
surface area for the exchange of oxygen into the blood and carbon dioxide out of it.2-4
The damage is permanent - not reversible - and it causes reduced respiratory function
and breathlessness. The damage takes a number of forms - the sacs can be destroyed, narrowed,
collapsed, stretched or over-inflated.

46
=>Causes:
The biggest known cause or risk factor for emphysema - and for COPD - is smoking.4,6-
8 Cigarette smoking is responsible for around 90% of cases of COPD. However, COPD will develop
only in smokers who are genetically susceptible - smoking does not always lead to the disease.

 cigarette smoke
Smoking is the leading cause of emphysema.
Other inhaled toxins also lead to emphysema and COPD, including work-related ones.
In developing countries, smoke from indoor cooking and heating is also an important cause.
While the following are not as important as primary cigarette smoke exposure, they
are minor contributory risk factors:
- Low body weight
- Childhood respiratory disorders
- Exposure to passive cigarette smoke
- Air pollution
- Occupational dust (mineral dust, cotton dust, for example)
- Inhaled chemicals (coal, grains, isocyanates, cadmium, for example).
Genetics are responsible for a rare form of COPD - emphysema can be caused by α1-
antitrypsin deficiency. The protein is necessary for protecting the lungs against neutrophil
elastase destruction of alveolar tissue.8,9 The deficiency is congenital - that is, people are born
with it.
The genetic disease affects non-smokers, explaining some of the cases, with onset
earlier in life, of COPD that are not caused by smoking. Smoking does, however, accelerate
genetically predisposed cases of emphysema.

=>Sign and Symptoms:

47
 Two symptoms are the main markers of emphysema and present early on:

 Cough is one of the main symptoms of emphysema.

 Shortness of breath
 Cough.
Shortness of breath is also known as dyspnea and gives the feeling of being unable
to catch a breath. This symptom may be present only during physical exertion but as the disease
progresses may be present during rest, too - emphysema and COPD take years to develop and
progress.
Other symptoms may be experienced, especially in more advanced lung disease:

 Frequent lung infections

 Producing a lot of mucus (phlegm or sputum)
 Wheezing
 Reduced appetite
 Weight loss
 Fatigue
 Blueness of the lips or fingernail beds (from cyanosis caused by poor respiration)
 Anxiety, depression
 Sleep problems
 Morning headache signals nighttime breathing difficulty (nocturnal hypercapnia or
hypoxemia)
Many of the symptoms of emphysema and COPD are shared by other medical conditions; it is
important to seek a doctor's examination and diagnosis.

=>Diagnosis:
Specific tests are used to identify emphysema and COPD, and doctors also perform
physical examinations and "take histories" (ask questions about the problem) to support a
diagnosis. This also helps to differentiate it from other conditions such as asthma and heart
failure.
If the cause of the emphysema is thought to be a rare case of α1-antitrypsin
deficiency - there has been no smoking or other typical risk factor, for example, or a close relative
has the deficiency - a laboratory test can be ordered to diagnose this.

 Lung function tests

Lung function tests - also called pulmonary function tests - are used to confirm a diagnosis of
emphysema. They measure the capacity of the lungs to exchange respiratory gases and include
spirometry.

48
  chest X-ray

A chest X-ray may be ordered during diagnosis.

Confirm airflow limitation
Quantify the severity and reversibility (in response to drugs) of the limitation
Differentiate COPD from other respiratory disorders.
Lung function tests also help to monitor the progression of the disease and to assess response to
treatment.
Spirometry assesses airflow obstruction and is measured according to the reduction in
forced expiratory volume after bronchodilator treatment.
For the test, patients blow as fast and hard as possible into a tube attached to a
machine that measures the volume and speed of air blown out.6
Forced expiratory volume in one second is abbreviated to FEV1. Four stages of COPD
from mild to severe are determined by the percentage of predicted (average healthy) values.

 Other tests
Other tests used by doctors in the process of diagnosing COPD and emphysema
include imaging of the lungs via chest X-ray or CT scanning (computed tomography), and arterial
blood gas analysis to assess O2/CO2 exchange.

=>Treatment:
There are two main elements to the management of COPD and emphysema:
medication and supportive therapy, which includes oxygen therapy and help with smoking

49
cessation. The stable chronic disease is continuously treated to relieve symptoms and prevent
exacerbations/complications, which are treated as they arise.
Emphysema makes people more vulnerable to flu - annual vaccination is
recommended.

 Drug therapies
The mainstay of medications used in people with COPD and emphysema are inhaled
bronchodilators to relieve symptoms. They help by relaxing and opening the air passages in the
lungs, and include these classes of drug:
Beta-agonists, which relax bronchial smooth muscle and increase mucociliary clearance
Anticholinergics (antimuscarinics), which relax bronchial smooth muscle.
These bronchodilators are equally effective when used regularly to improve lung
function and increase exercise capacity.8 The particular use of short- versus long-acting drugs, or
of combination treatment, depends on individual factors, preferences and symptoms. Example
bronchodilators include albuterol, formoterol, indacaterol and salmeterol.
Corticosteroid drugs may also be prescribed for people with COPD and emphysema,
including fluticasone at between 500 and 1,000 micrograms a day and beclomethasone at 400 to
2,000 micrograms a day. Steroids are inhaled as an aerosol spray, and can help relieve symptoms
of emphysema associated with asthma and bronchitis.
Corticosteroids may be introduced in people who have poorly controlled symptoms
and regularly suffer exacerbations in spite of bronchodilator use.
In patients with COPD who continue to smoke, corticosteroids do not alter the course
of the disease, but they do relieve symptoms and improve short-term lung function in some
patients. They also have an additive effect to bronchodilators, and can reduce exacerbation
frequency.

 Oxygen therapy
As emphysema progresses and respiratory function declines, this makes independent
breathing increasingly difficult. Oxygen therapy improves oxygen delivery to the lungs by
supplementing it via a number of device options, including those used in the home.
Delivery is by electrically driven oxygen concentrators, liquid oxygen systems, or
cylinders of compressed gas, depending on back-up needs and how much time is spent outdoors
or at home.
Oxygen or O2 therapy can be administered 24 hours a day or 12 hours nocturnally. It
prolongs life for people with advanced COPD and emphysema. Treatment will be monitored with
oxygen saturation measurements and possibly sleep studies.
50
  Pulmonary rehabilitation
Pulmonary rehabilitation is a program of care for people with emphysema that
includes the below supportive measures of help with smoking cessation and nutrition, but also
includes help with physical activities - exercise, education and behavioral interventions.
Pulmonary rehabilitation may not change the overall course of the illness but can
improve an ability to live with the condition, and improve exercise capacity and quality of life.

Homoeopathic treatment for Emphysema

(1) Ammonium-carb:
Atony of bronchial tubes; copious accumulation of mucus in lungs, dilatation of
bronchial tubes and edema pulmonum; asthmatic oppression of breathing with stitches in chest,
(<) on physical effort or magic oppression of breathing with stitches in chest, (<) on physical effort
or when entering a warm room; cough continual, but raises nothing or only a when entering a
warm room; cough continual, but raises nothing or only a little with difficulty, (<) 3 to 4 A.M.,
with rattling of large bubbles in chest, feels faint from the effort to breathe; drowsy and cyanotic
from blood-poisoning by carbonic acid.

(2) Antimonium-tart:
EXCESSIVE dyspnoea, must be supported in a sitting posture in bed; great rattling of
mucus in bronchial tubes, particularly just below the larynx; gasping for breath at the beginning
of every coughing spell; violent pains from chest to shoulder.

(3) Arsenicum:
Highest degree of dyspnoea, even to suffocation, with great anxiety and restlessness;
tightness of chest as if bound by a hoop; burning in chest; face cyanotic and covered with cold
perspiration; bronchorrhoea.

(4) Bromium:
After pneumonia, asthma, cough dry, whistling, tickling in larynx; gasping for breath
with wheezing and rattling high up and spasmodic closure of glottis; he cannot inspire deep
enough; pressure in stomach, must sit up in bed at night.

(5) Camphora:

51
 Dyspnoea (<) after any bodily
exertion; cough from talking, inhaling air and a feeling of coldness which commences at the pit
of stomach, spreading over chest and is exhaled as cold breath.

(6) Carbo-veg:
Often after Ars: neglected chronic bronchitis. Great dyspnoea and anxiety, but no
restlessness; cough in violent spells; watery, profuse expectoration; breathing short, with cold
hands and feet; cold breath; blueness of skin, (>) from hard fanning; threatened paralysis of
ALVEOLI.

(7) Chininum-ars:
Regularly even forenoon at 9 A.M. attacks of suffocating spells in tuberculosis; limbs
icy cold; cold, clammy sweat all over; greatest anxiety and unquenchable thirst; must sit up,
bent forward if possible, at an open window.

(8) Chlorum:
EASY INHALATION; EXHALATION IMPOSSIBLE; breathing consists of a succession of
crowing inspirations, each followed by an ineffectual effort at expiration, inflating chest to a
painful extent face turgid and livid; convulsive movements; expiration difficult, prolonged,
insufficient, as if air cells were hardly half empty.

52
 (4) Bronchitis
Also known as BLUE BOTTER
Bronchitis is inflammation of the bronchi (large and medium-sized airways) in the
lungs. Symptoms include coughing up mucus, wheezing, shortness of breath, and chest
discomfort. Bronchitis is divided into two types: acute and chronic. Acute bronchitis is also known
as a chest cold.
Acute bronchitis usually has a cough that lasts around three weeks. In more than 90%
of cases the cause is a viral infection. These viruses may be spread through the air when people
cough or by direct contact. Risk factors include exposure to tobacco smoke, dust, and other air
pollution. A small number of cases are due to high levels of air pollution or bacteria such as
Mycoplasma pneumoniae or Bordetella pertussis. Treatment of acute bronchitis typically
involves rest, paracetamol (acetaminophen), and NSAIDs to help with the fever.
Chronic bronchitis is defined as a productive cough that lasts for three months or more
per year for at least two years. Most people with chronic bronchitis have chronic obstructive
pulmonary disease (COPD). Tobacco smoking is the most common cause, with a number of other
factors such as air pollution and genetics playing a smaller role. Treatments include quitting
smoking, vaccinations, rehabilitation, and often inhaled bronchodilators and steroids. Some
people may benefit from long-term oxygen therapy or lung transplantation.

• term that describes inflammation of the bronchial tubes (bronchi and the smaller
branches termed bronchioles) that results in excessive secretions of mucus into the tube
with tissue swelling that may narrow or close off bronchial tubes.
• Chronic bronchitis is defined as a cough that occurs every day with sputum production
that lasts for at least 3 months, 2 years in a row.

53
=>Causes:
The major cause of chronic bronchitis is cigarette smoking; other causes.
Most often, the same viruses that give you a cold or the flu also cause bronchitis. Sometimes,
though, bacteria are to blame.
In both cases, as your body fights off the germs, your bronchial tubes swell and make more
mucus. That means you have smaller openings for air to flow, which can make it harder to
breathe.
If any of these things describe your situation, you have a bigger chance of getting bronchitis:
• You have a weaker immune system. This is sometimes the case for older adults and people
with ongoing diseases, as well as for babies and young children. Even a cold can make it more
likely since your body’s already busy fighting off those germs.
• You smoke or live with a smoker.
• You have heartburn (also called gastric reflux or GERD), which can cause stomach acids to
get into your bronchial tubes.
• You work around substances that bother your lungs, such as chemical fumes or dust.
(Examples: coal mining, working around farm.)

=>Symptoms:

Persistent cough, which may produce mucus

Wheezing
Low fever and chills
Blocked nose and sinuses
One of the main symptoms of acute bronchitis is a cough that lasts for several weeks. It can
sometimes last for several months if the bronchial tubes take a long time to heal fully.

54
It is common for the symptoms of chronic bronchitis to get worse two or more times every year,
and they are often worse during the winter months.
However, a cough that refuses to go away could also be a sign of another illness such as asthma
or pneumonia.

=>Diagnosis of bronchitis:
• Bronchitis is a term that describes inflammation of the bronchial tubes (bronchi and the
smaller branches termed bronchioles) that results in excessive secretions of mucus into the tubes
with tissue swelling that may narrow or close off bronchial tubes.
• Chronic bronchitis is defined as a cough that occurs every day with sputum production
that lasts for at least 3 months, 2 years in a row.
• The major cause of chronic bronchitis is cigarette smoking; other causes are bronchial
irritants, usually inhaled repeatedly by the affected person.
• Ideally, people should seek medical care before chronic bronchitis develops. People
should seek care for tobacco addiction and the occasional chronic cough (less than daily for 3
months) to potentially avoid developing chronic bronchitis. Those with chronic bronchitis should
seek care for severe dyspnea, cyanosis, and fever immediately.
• Clinical history and physical exams help diagnose chronic bronchitis, while other tests
such as chest X-rays, pulmonary function tests, and CT imaging studies may also be used.
• Treatment of most people with chronic bronchitis is to quit cigarette smoking and avoid
air-borne bronchial irritants; medical treatments include bronchodilators, steroids, and oxygen
therapy.
• The major complications of chronic bronchitis are severe shortness of breath, COPD,
respiratory failure, and an increased mortality rate.
• Risk factors for chronic bronchitis include smoking, exposure to airborne chemicals and
secondhand smoke, dust, and other bronchial irritants.

55
• A majority of cases of chronic bronchitis can be prevented by not smoking and avoiding
secondhand smoke. Avoidance of air-borne bronchial irritants, vaccinations, and asthma
prevention may help prevent bouts of chronic bronchitis.

Bronchitis is a term that describes inflammation of the bronchial tubes (bronchi and the smaller
branches termed bronchioles) that results in excessive secretions of mucus into the tubes with
tissue swelling that may narrow or close off bronchial tubes.
• Chronic bronchitis is defined as a cough that occurs every day with sputum production
that lasts for at least 3 months, 2 years in a row.
• The major cause of chronic bronchitis is cigarette smoking; other causes are bronchial
irritants, usually inhaled repeatedly by the affected person.
• Ideally, people should seek medical care before chronic bronchitis develops. People
should seek care for tobacco addiction and the occasional chronic cough (less than daily for 3
months) to potentially avoid developing chronic bronchitis. Those with chronic bronchitis should
seek care for severe dyspnea, cyanosis, and fever immediately.
• Clinical history and physical exams help diagnose chronic bronchitis, while other tests
such as chest X-rays, pulmonary function tests, and CT imaging studies may also be used.

• Treatment of most people with chronic bronchitis is to quit cigarette smoking and avoid
air-borne bronchial irritants; medical treatments include bronchodilators, steroids, and oxygen
therapy.
• The major complications of chronic bronchitis are severe shortness of breath, COPD,
respiratory failure, and an increased mortality rate.

56
• Risk factors for chronic bronchitis include smoking, exposure to airborne chemicals and
secondhand smoke, dust, and other bronchial irritants.
• A majority of cases of chronic bronchitis can be prevented by not smoking and avoiding
secondhand smoke. Avoidance of air-borne bronchial irritants, vaccinations, and asthma
prevention may help prevent bouts of chronic bronchitis.
• Although the disease is chronic and progressives
• Yellowish expectoration
Symptoms of acute bronchitis may include:
• cough,
• wheezing,
• fever,
• chills and malaise, and
• shortness of breath especially with exertion.
How Is It Diagnosed?
Your doctor usually can tell whether you have bronchitis based on a physical exam and your
symptoms. She’ll ask questions about your cough, such as how long you’ve had it and what kind
of mucus comes up with it. She’ll also listen to your lungs to see whether anything sounds wrong,
like wheezing.
That’s usually it, but in some cases, your doctor may:
• Check the oxygen levels in your blood. This is done with a sensor that goes on your toe or
finger.
• Do a lung function test. You’ll breathe into a device called a spirometer to test for
emphysema (a type of COPD in which air sacs in your lungs thin out and are destroyed) and
asthma.
• Give you a chest X-ray. This is to check for pneumonia or another illness that could cause
your cough
• Order blood tests.
• Test your mucus to rule out diseases caused by bacteria. One of these is whooping cough,
which is also called pertussis. It causes violent coughing that makes it hard to breathe.

=>Treatment:

57
 People suffering from bronchitis are usually instructed to rest, drink fluids, breath
warm and moist air, and take OTC cough suppressants and pain relievers to manage symptoms
and ease breathing.
Many cases of acute bronchitis go away without any specific treatment, but there is no
cure for chronic bronchitis. To keep bronchitis symptoms under control and relieve symptoms,
doctors might prescribe:

 Cough medicine - although coughing should not be completely suppressed as this is an

important way to bring up mucus and remove irritants from the lungs.
 Bronchodilators - these open the bronchial tubes and clear out mucus.
 Mucolytic - these thin or loosen mucus in the airways, making it easier to cough up
sputum.
 Anti-inflammatory medicines and glucocorticoid steroids - these are for more persistent
symptoms to help decrease chronic inflammation that may cause tissue damage.
 Oxygen therapy - this helps improve oxygen intake when breathing is difficult.
 Pulmonary rehabilitation program - this includes work with a respiratory therapist to help
improve breathing.
 Antibiotics – these are effective for bacterial infections, but not for viral infections. They
may also prevent secondary infections.
Additional behavioral remedies include:
Removing the source of irritation to the lungs - for example, by stopping smoking
Using a humidifier - this can loosen mucus and relieve limited airflow and wheezing
Exercise - this will strengthen the muscles involved in breathing
Breathing exercises - for example, pursed-lip breathing that helps to slow breathing down

Homoeopathic treatment for Bronchitis

(1) Aesculus-hip:
Bronchitis complicated with gouty diathesis and a tendency to piles with
constipation; rapid, labored breathing with pain in right lung.

(2) Allium-sativum:
Herpetic constitution; the poison attacks the respiratory and digestive mucous
membranes; chronic, pulmonary catarrh; dry cough, from scraping in the larynx; afterwards
glutinous, bloody or purulent sputa of foul odor. Dyspnoea, as if the anterior chest were

58
compressed; pains in chest, so that he cannot expand it; stitches in shoulder-blades and pectoral
muscles, increased by cough and deep inspiration; (<) by fresh, cold air, by atmospheric changes,
after rest and from washing the head, general chilliness with redness of face; sour, fetid sweat in
the afternoon; general lassitude.

(3) Alumen:
Coughs a long time every morning, with scratching in the middle of the sternum, on
and after getting up, (<) during, (>) after breakfast; chronic morning cough of old people; sputa
ropy and scanty; dry cough in the evening after cold air, by atmospheric changes, after rest and
from washing the head, general chilliness with redness of face; sour, fetid sweat in the afternoon;
general lassitude.

(4) Alumina:
(Argilla). - Dry, hacking cough soon after waking in the morning, ending in difficult
raising of a little white mucus; cough with tearing pains and involuntary urination in old or
withered looking people; (<) in the cold season and lasting till the warm season sets in again,
cough (>) by lying flat on the face; sputum difficult and of a putrid taste.

(5)Ambra :
violent tickling in throat, evening without, morning with expectoration, generally of
grayish-white, seldom of yellow mucus, of salty or sour taste, excited by exertion and music;
violent spasmodic cough, with paroxysms of cough coming from deep in chest, excited by
exertion and music; violent spasmodic cough, with frequent eructations and hoarseness; aged
people; old cough.

(6) Ammonium-carb:
BRONCHITIS OF THE AGED. Copious bronchial secretion, with great difficulty of
expectoration and bronchial dilatation. Numerous coarse rattles land yet he experiences no
necessity to clear his chest. Cough in the morning or at night, disturbing sleep, with spasmodic
oppression, incessant cough, excited by a sensation as if down in the larynx; (<) after eating,
talking, in the open air, and on lying down, followed by exhaustion. Low VITALITY; AND ATONY
OF THE BRONCHIAL TUBES, favoring emphysema. Catarrh of old people, beginning with the
setting in of winter and continuing till summer heat prevails, (<) 3 to 4 A.M.

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 (5) BRONCHIECTASIS
=>Introduction:
Bronchiectasis is a condition where the bronchial tubes of your lungs are permanently
damaged, widened, and thickened. These damaged air passages allow bacteria and mucus to
build up and pool in your lungs. This results in frequent infections and blockages of the airways.
Bronchiectasis is manageable, but it cannot be cured. With treatment, you can typically
live a normal life. However, flare-ups must be treated quickly so that oxygen flow is maintained
to the rest of your body and further lung damage is prevented.

=>Causes:
Bronchiectasis has both congenital and acquired causes, with the latter more frequent.
Cystic fibrosis is a cause in up to half of cases. The cause in 10-50% of those without cystic fibrosis
is unknown; bronchiectasis without CF is known as non-CF bronchiectasis (NCBE).

Acquired causes
Bronchiectasis secondary to a large carcinoid tumor (not shown) that was completely
obstructing the bronchus proximally. The yellowish discoloration of lung parenchyma reflects
obstructive pneumonia.
Tuberculosis, pneumonia, inhaled foreign bodies, allergic bronchopulmonary
aspergillosis and bronchial tumors are the major acquired causes of bronchiectasis. Infective
causes associated with bronchiectasis include infections caused by the Staphylococcus,
Klebsiella, or Bordetella pertussis, the causative agent of whooping cough.
Aspiration of ammonia and other toxic gases, pulmonary aspiration, alcoholism, heroin
(drug use), various allergies all appear to be linked to the development of bronchiectasis. Various
immunological and lifestyle factors have also been linked to the development of bronchiectasis:

60
 Childhood Acquired Immune Deficiency Syndrome (AIDS), which predisposes patients
to a variety of pulmonary ailments, such as pneumonia and other opportunistic infections.
Inflammatory bowel disease, especially ulcerative colitis. It can occur in Crohn's
disease as well, but does so less frequently. Bronchiectasis in this situation usually stems from
various allergic responses to inhaled fungal spores. A Hiatal hernia can cause Bronchiectasis when
the stomach acid that is aspirated into the lungs causes tissue damage. Rheumatoid arthritis
sufferers who smoke appear to have a tenfold increased prevalence of the disease. Still, it is
unclear as to whether or not cigarette smoke is a specific primary cause of bronchiectasis.
No cause is identified in up to 50% of non-cystic-fibrosis related bronchiectasis.

Congenital causes
Bronchiectasis may result from congenital disorders that affect cilia motility or ion
transport. Kartagener syndrome is one such disorder of cilia motility linked to the development
of bronchiectasis. A common cause is cystic fibrosis, which affects chloride ion transport, in which
a small number of patients develop severe localized bronchiectasis. Young's syndrome, which is
clinically similar to cystic fibrosis, is thought to significantly contribute to the development of
bronchiectasis. This is due to the occurrence of chronic infections of the sinuses and bronchiole
tree.
Other less-common congenital causes include primary immunodeficiencies, due to
the weakened or nonexistent immune system response to severe, recurrent infections that
commonly affect the lung. Several other congenital disorders can also lead to bronchiectasis,
including Williams-Campbell syndrome and Marfan syndrome. Patients with alpha 1-antitrypsin
deficiency have been found to be particularly susceptible to bronchiectasis, for unknown reasons.

=>Pathophysiology:
Bronchiectasis is a result of chronic inflammation compounded by an inability to clear
mucoid secretions. This can be a result of genetic conditions resulting in a failure to clear sputum
(primary ciliary dyskinesia), or resulting in more viscous sputum (cystic fibrosis), or the result of
chronic or severe infections. Inflammation results in progressive destruction of the normal lung
architecture, in particular, the elastic fibers of bronchi.
Endobronchial tuberculosis commonly leads to bronchiectasis, either from bronchial
stenosis or secondary traction from fibrosis.

=>Sign and Symptoms:

Symptoms of bronchiectasis can take months or even years to develop. Some typical symptoms
include:

61
  chronic daily cough
 coughing up blood
 abnormal sounds or wheezing in the chest with breathing
 shortness of breath
 chest pain
 coughing up large amounts of thick mucus every day
 weight loss
 fatigue
 thickening of the skin under your nails and toes, known as clubbing
 frequent respiratory infections

=>Diagnosis:
Bronchiectasis may be diagnosed clinically or on review of imaging. The British Thoracic
Society recommends all non-cystic-fibrosis-related bronchiectasis be confirmed by CT. CT may
reveal tree-in-bud abnormalities, dilated bronchi, and cysts with defined borders.
Other investigations typically performed at diagnosis include blood tests, sputum cultures,
and sometimes tests for specific genetic disorders.

=>Treatment:
There’s no cure for bronchiectasis, but treatment is important to help you manage the
condition. The main goal of treatment is to keep infections and bronchial secretions under
control. It’s also critical to prevent further obstructions of the airways and minimize lung damage.
Common methods of treating bronchiectasis may include:

 methods for clearing the airways (like breathing exercises and chest physiotherapy)
 pulmonary rehabilitation
 antibiotics to prevent and treat infection
 bronchodilators like albuterol (Proventil) and tiotropium (Spiriva) to open up airways
 medications to thin mucus
 expectorants to aid in coughing up mucus
 oxygen therapy
 vaccinations to prevent respiratory infections
You may need the help of chest physiotherapy. One form is a high-frequency chest wall
oscillation vest to rid your lungs of mucus. The vest gently compresses and releases your chest,
creating the same effect as a cough. This dislodges mucus from the walls of the bronchial tubes.
If there’s bleeding in the lung, or if the bronchiectasis is located in only one part of
your lung, surgery may be needed to remove the affected area.

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 Homeopathic management for bronchiectasis
Role of homeopathy:
Homeopathy relieves the cough symptoms. it relieves the breathing problem and fatigue
condition. Increase of weight occurs in many patients after our treatment.
In our Multicare homeopathy online treatment center peoples suffering from
bronchiectasis have been benefitted using our advanced homeopathic treatment packages. We
apply the most scientific and research based homeopathy treatment package for bronchiectasis
that gives a long standing improvement to the ailment.

(1)Arsenic :
This homeopathic remedy corresponds to the general phenomena of the cancerous
diathesis, though Bayes notes that we have other remedies which may possess more power over
cancer indicated. It is said to be almost a specific for lupus, and its special indications in any form
of tumor, be it cancer or not, the sharp burning and lancinating pain, the weakness and debility
and the general Arsenicum symptoms known so well. In other words, the patient is to be treated,
not the disease.

(2) Alumen:
Coughs a long time every morning, with scratching in the middle of the sternum, on
and after getting up, (<) during, (>) after breakfast; chronic morning cough of old people; sputa
ropy and scanty; dry cough in the evening after cold air, by atmospheric changes, after rest and
from washing the head, general chilliness with redness of face; sour, fetid sweat in the afternoon;
general lassitude.

(3) Phosphorus:
When bronchial symptoms are present it is the remedy, and cerebral symptoms during
pneumonia often yield better to Phosphorus than to Belladonna.
There is cough; with pain under sternum, as if something were torn loose; there
is pressure across the upper part of the chest and constriction of the larynx; there is pressure
When typhoid symptoms occur in the course of pneumonia then Phosphorus will come in
beautifully. Phosphorus follows Bryonia well, being complementary to it. There is also a sensation
as if the chest were full of blood, which causes an oppression; of breathing, a symptom met with
commonly enough in pneumonia.
Hughes maintains that Phosphorus should be given in preference to almost any
medicine in acute chest affections in young children. Lilienthal says Phosphorus is our great tonic
to the heart and lungs. Hyoscyamus. Dr. Nash considers this across the upper part of the chest
and constriction of the larynx; there are mucous rales, labored breathing, sputa yellowish mucus,

63
with blood streaks therein, or rust colored, as under Bryonia. After Phosphorus, Hepar sulphur.
naturally follows as the exudate begins to often; it is the remedy of the third stage, the fever is;
of a low character. Tuberculinum. Arnulphy says that in lobular pneumonia this remedy surpasses
Phosphorus or Antimonium tartaricum, and competent observers are convinced that it has an
important place in the treatment of pneumonia; some using it in very case intercurrently; doses
varying from 6x to 3ox.

(4) Sanguinaria:
When Sanguinaria is indicated in pneumonia there will be fever, burning and fullness
in the upper chest, a dry cough, sharp, sticking pains more on the right side, dyspnoea, and the
expectoration is rust-colored, here resembling Phosphorus. It has circumscribed redness and
burning heat of the cheeks, especially in the afternoon. The hands and feet are either very hot or
very cold, the heart is weak and irregular, there is great engorgement of the lungs and the
congestion is very intense, here resembling Veratrum viride. Sanguinaria has imperfect
resolution and purulent expectoration, as in Sulphur but it is more offensive, even becoming so
to the patient himself.

(5) Ant tart:

Causation: Exposure to damp basement and cellars. bad effects of vaccination.
Difficult suffocation in the evening and at 3 a.m. compelling the patient to sit up due to <
of cough with less or no expectoration of mucus. LOUD RATTLING DUE TO LARGE
ACCUMULATION OF MUCUS IN BRONCHI which can be heard across the entire room.

64
 DISEASE AFFFECTING THE AIR SACS

(6) PNEUMONIA
Pneumonia is an inflammation of the lung caused by infection with bacteria,
viruses, and other organisms. Pneumonia is usually triggered when a patient’s defense system is
weakened, most often by a simple viral upper respiratory tract infection or a case of influenza.
Such infections or other triggers do not cause pneumonia directly but they alter the mucous
blanket, thus encouraging bacterial growth. Other factors can also make specific people
susceptible to bacterial growth and pneumonia.

=>Causes:
Bacteria are the most common causes of pneumonia, but these infections can
also be caused by other microbial organisms. It is often impossible to identify the specific culprit.
The most common cause of pneumonia is the gram-positive bacterium Streptococcus
pneumoniae (also called S. pneumoniae or pneumococcal pneumonia). The most common gram-
negative species causing.
Haemophilus influenzae (generally occurring in patients with chronic lung
disease, older patients, and alcoholics).
Atypical pneumonias are generally caused by tiny nonbacterial organisms called
Mycoplasma or Chlamydia pneumoniae and produce mild symptoms with a dry cough. Viruses
that can cause or lead to pneumonia include influenza, respiratory syncytial virus (RSV), herpes
simplex virus, varicella-zoster (the cause of chickenpox), and adenovirus.

=>Sign and Symptoms:

Symptoms caused by bacteria usually come on quickly. They may include: Cough. You
will likely cough up mucus (sputum) from your lungs. Mucus may be rusty or green or tinged with
blood.

65
 Fever.
Fast breathing and feeling short of breath.
Shaking and "teeth-chattering" chills.
Chest pain that often feels worse when you cough or breathe in.
Fast heartbeat.
Feeling very tired or very weak.
Nausea and vomiting.
Diarrhea.
When you have mild symptoms, your doctor may call this "walking pneumonia."
Older adults may have different, fewer, or milder symptoms. They may not have a
fever. Or they may have a cough but not bring up mucus. The main sign of pneumonia in older
adults may be a change in how well they think. Confusion or delirium is common. Or, if they
already have a lung disease, that disease may get worse.
Symptoms caused by viruses are the same as those caused by bacteria. But they may
come on slowly and often are not as obvious or as bad.
The symptoms of bacterial pneumonia develop abruptly and may include chest pain,
fever, shaking, chills, shortness of breath, and rapid breathing and heartbeat. Symptoms of
pneumonia indicating a medical emergency include high fever, a rapid heart rate, low blood
pressure bluish-skin.

Main symptoms of infectious pneumonia

Symptoms of Pneumonia Causes by Anaerobic Bacteria
People with pneumonia caused by anaerobic bacteria such as Bacteroides, which
can produce abscesses, often have prolonged fever and productive cough, frequently showing
blood in the sputum, which indicates necrosis (tissue death) in the lung. About a third of these
patients’ experience weight loss.

=>Diagnosis:

66
 Your doctor will ask you about your symptoms and do a physical exam. He or she may
order a chest X-ray and a complete blood count (CBC). This is usually enough for your doctor to
know if you have pneumonia. You may need more tests if you have bad symptoms, are an older
adult, or have other health problems. In general, the sicker you are, the more tests you may need.
Your doctor may also test mucus from your lungs to find out if bacteria are causing your
pneumonia. Finding out what is causing your pneumonia can help your doctor choose the best
treatment for you.

=>Treatment:
Oral antibiotics, rest, simple analgesics, and fluids usually suffice for complete
resolution. However, those with other medical conditions, the elderly, or those with significant
trouble breathing may require more advanced care.
If the symptoms worsen, the pneumonia does not improve with home treatment, or
complications occur, hospitalization may be required. Worldwide, approximately 7–13% of cases
in children result in hospitalization, whereas in the developed world between 22 and 42% of
adults with community-acquired pneumonia are admitted.
The CURB-65 score is useful for determining the need for admission in adults. If the
score is 0 or 1, people can typically be managed at home; if it is 2, a short hospital stay or close
follow-up is needed; if it is 3–5, hospitalization is recommended. [48] In children those with
respiratory distress or oxygen saturations of less than 90% should be hospitalized. The utility of
chest physiotherapy in pneumonia has not yet been determined. Non-invasive ventilation may
be beneficial in those admitted to the intensive care unit. Over-the-counter cough medicine has
not been found to be effective nor has the use of zinc in children. There is insufficient evidence
for mucolytics.
Bacterial
Antibiotics improve outcomes in those with bacterial pneumonia. Antibiotic choice
depends initially on the characteristics of the person affected, such as age, underlying health,
and the location the infection was acquired. In the UK, treatment before culture results with
amoxicillin is recommended as the first line for community-acquired pneumonia, with
doxycycline or clarithromycin as alternatives. In North America, where the "atypical" forms of

67
community-acquired pneumonia are more common, macrolides (such as azithromycin or
erythromycin), and doxycycline have displaced amoxicillin as first-line outpatient treatment in
adults. In children with mild or moderate symptoms, amoxicillin remains the first line. The use of
fluoroquinolones in uncomplicated cases is discouraged due to concerns about side-effects and
generating resistance in light of there being no greater clinical benefit.
For those who require hospitalization and caught their pneumonia in the community
the use of a β-lactam such as cephazolin plus macrolide such as azithromycin or a
fluoroquinolones is recommended. The addition of corticosteroids also appears to improve
outcomes.
Viral
Neuraminidase inhibitors may be used to treat viral pneumonia caused by
influenza viruses (influenza A and influenza B). No specific antiviral medications are
recommended for other types of community acquired viral pneumonias including SARS
coronavirus, adenovirus, hantavirus, and parainfluenza virus. Influenza A may be treated with
rimantadine or amantadine, while influenza A or B may be treated with oseltamivir, zanamivir or
peramivir. These are of most benefit if they are started within 48 hours of the onset of symptoms.
Many strains of H5N1 influenza A, also known as avian influenza or "bird flu", have
shown resistance to rimantadine and amantadine. The use of antibiotics in viral pneumonia is
recommended by some experts, as it is impossible to rule out a complicating bacterial infection.
The British Thoracic Society recommends that antibiotics be withheld in those with mild disease.
The use of corticosteroids is controversial.

Homoeopathic treatment for Pneumonia

(1) Aconite:
Probably no fact is more fully established in medicine, in any school, than the
beneficial action of Aconite action of Aconite in pulmonary congestions, it corresponds more
closely to the symptoms usually found in that stage. It should not, however, be used in this or
any disease in the first or any stage unless the symptoms call for it.
The symptoms are these: High fever preceded by a distinct chill; the pulse is full,
hard and tense; a history of exposure may also be taken into consideration; dry, cold winds. The
skin is hot and dry, without moisture upon it; there is a hard, dry, teasing and painful cough; there
may be some expectoration present, if so it is watery, serous and frothy, may be blood tinged,
but not thick. Thick expectoration indicates that exudation is commencing, and then Aconite is
no longer the remedy. There is pain also with Aconite, which is poorly borne. With these
symptoms there is great restlessness.

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(2) Ferrum phosphoricum:
This, like Aconite, is a remedy for the first stage before exudation takes place,
and, like Aconite, if there be any expectoration it is thin, watery and blood streaked. It is a useful
remedy for violent congestions of the lungs, whether appearing at the onset of the diseases or
during its course, which would show that the inflammatory action was extending; it thus
corresponds to what are termed secondary pneumonias, especially in the aged and debilitated.
There is high fever, oppressed and hurried breathing, and bloody expectoration, very little thirst;
there are extensive rales, and perhaps less of that extreme restlessness and anxiety that
characterizes Aconite. This remedy, with kali muriaticum, forms the Schuesslerian treatment of
this disease

(3) Iodine:
this remedy is one both for the first and second stage of pneumonia, especially
for the croupous form. It has high fever and restlessness like aconite, and there is a tendency to
rapid extension of the hepatization. There is a decided cough and great difficulty in breathing, as
if the chest would not expand; the sputum is blood streaked. Iodine may also be a remedy in the
later stages when resolution does not progress, the lung breaking down with hectic and
suppurative symptoms.
Dr. Kafka, our celebrated German confrere, prescribed drop doses of Iodine in
the 1st,2d or 3d dilution every hour or so as soon as physical signs of pneumonia showed
themselves, and claimed that it would arrest the process of hepatization within twenty-four
hours. He considered that Aconite was entirely unnecessary in the treatment of pneumonia. It is
also favorably.

(4) Veratrum viride:

In violent congestions about the chest preceding pneumonia Veratrum viride
may be the remedy, and thus it is seeming that its use is more in the beginning of the disease,
and especially where there is great arterial excitement, dyspnoea, chest oppression and stomach
symptoms of nausea and vomiting; the engorgement is profound, and here it greatly resembles
Sanguinaria; but it differs from that drug, in that it is of; little use after hepatization has taken
place.
There is high fever, violent action of the heart, the pulse is full, hard and rapid,
and the tongue has a red streak down the center; this latter symptom is a characteristic keynote
of the drug. The air cells at the bottom of the lobes are filling up with frothy mucus. the pulse will
indicate, it being full and hard. Hard, quick and small indicates Aconite. Strike out anxiety and
alarm and insert an ugly delirium with a deeply flushed, bloated face and headache and you have
veratrum viride. One must beware not to encourage cardiac depression with this remedy.

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(5) Bryonia:
the remedy for pneumonia; it furnishes a better pathological picture of the
disease than any other, and it comes in after Aconite, Ferrum phosphoricum and Veratrum viride.
The fever continues, but the and moister than that of Aconite, and there are usually sharp
stitching pleuritic pains, the cough of Bryonia is also hard and dry at times and the sputum is
scanty and rust colored, so typical of pneumonia.
There may be circumscribed redness of the cheeks, slight delirium and apathy;
the tongue will most likely be dry, and the patient will most likely be dry, l and the patient will
want to keep perfectly quiet. It is a right-sided remedy and attacks the parenchyma of the lung,
and is perhaps more strongly indicated in the croupous form of pneumonia. The patient dreads
to cough and holds his breath to prevent it on account of the pain it causes; it seems as though
the chest walls would fly to pieces.
The pains in the chest, besides being worse by motion and breathing, are
relieved by rest; skin is not as hot and the patient not as restless as in Aconite. the cough of
Bryonia is looser and moister than that of Aconite, and there are usually sharp stitching pleuritic
pains, the cough of Bryonia is also hard and dry at times and the sputum is scanty and rust
colored, so typical of pneumonia. There may be circumscribed redness of the cheeks, slight
delirium and apathy; the tongue will most likely be dry, and the patient will most likely be dry, l
and the patient will want to keep perfectly quiet. It is a right-sided painful side, because this
lessens the motions; of that side.
Coughs which hurt distant parts of the body call for Bryonia. Phosphorus most
commonly follows Bryonia in pneumonia, and is complementary. In pneumonias complicated by
pleurisy Bryonia is the remedy, par excellence. Halbert believes that Cantharis relieves the painful
features of the early development of the exudate better than any other remedy, a hint which
comes from Dr. Jousset, who used the remedy extensively remedy and attacks the parenchyma
of the lung, and is perhaps more strongly indicated in the croupous form of pneumonia.
The patient dreads to cough and holds his breath to prevent it on account of
the pain it causes; it seems as though the chest walls would fly to pieces. The pains in the chest,
besides being worse by motion and breathing, are relief.

(6) Kali muriaticum:

Since the advent of Schuesslerism this has been a favorite remedy with some
physicians, and not without a good ground for its favoritism. Clinical experience has proved that
this drug in alternation with Ferrum phosphoricum constitutes a treatment of pneumonia which
has been very successful in many hands. The symptoms calling for Kali muriaticum as laid down
by Schuessler are very meager, it is given simply because there is a fibrinous exudation in the
lung substance. There is a white, viscid expectoration and the tongue is coated white. It is better

70
suited to the second stage, for when the third stage appears with its thick, yellowish
expectoration it is replaced by Kali sulphuricum in the biochemic nomenclature.

(6) Phosphorus:
“the great mogul of lobar pneumonia.” It should be remembered that
Phosphorus is not, like Bryonia, the remedy when the lungs are completely hepatized, although
it is one of the few drugs which have been known to produce hepatization. When bronchial
symptoms are present it is the remedy, and cerebral symptoms during pneumonia often yield
better to Phosphorus than to Belladonna.
There is cough; with pain under sternum, as if something were torn loose; there
is pressure across the upper part of the chest and constriction of the larynx; there is pressure
When typhoid symptoms occur in the course of pneumonia then Phosphorus will come in
beautifully. Phosphorus follows Bryonia well, being complementary to it. There is also a sensation
as if the chest were full of blood, which causes an oppression; of breathing, a symptom met with
commonly enough in pneumonia.
Hughes maintains that Phosphorus should be given in preference to almost any
medicine in acute chest affections in young children. Lilienthal says Phosphorus is our great tonic
to the heart and lungs. Hyoscyamus. Dr. Nash considers this across the upper part of the chest
and constriction of the larynx; there are mucous rales, labored breathing, sputa yellowish mucus,
with blood streaks therein, or rust colored, as under Bryonia. After Phosphorus, Hepar sulphur.
naturally follows as the exudate begins to often; it is the remedy of the third stage, the fever is;
of a low character. Tuberculinum. Arnulphy says that in lobular pneumonia this remedy surpasses
Phosphorus or Antimonium tartaricum, and competent observers are convinced that it has an
important place in the treatment of pneumonia; some using it in very case intercurrently; doses
varying from 6x to 3ox

(7) Sanguinaria:
When Sanguinaria is indicated in pneumonia there will be fever, burning and
fullness in the upper chest, a dry cough, sharp, sticking pains more on the right side, dyspnoea,
and the expectoration is rust-colored, here resembling Phosphorus. It has circumscribed redness
and burning heat of the cheeks, especially in the afternoon. The hands and feet are either very
hot or very cold, the heart is weak and irregular, there is great engorgement of the lungs and the
congestion is very intense, here resembling Veratrum viride. Sanguinaria has imperfect
resolution and purulent expectoration, as in Sulphur but it is more offensive, even becoming so
to the patient himself.

(8) Chelidonium:
Bilious pneumonia is, perhaps more often indicative of Chelidonium than of any
other remedy. there are stitching pains under the right scapula, loose rattling cough and difficult

71
expectoration, oppression; of chest, as under Antimonium tartaricum, and fan-like motions of
the alae nasi, as under Lycopodium. Mercurius is quite similar in bilious pneumonia; the stools
will decide, those of Mercurius being slimy and accompanied by tenesmus; the expectoration is
also apt to be blood-streaked.
With chelidonium there is an excess of secretion in the tubes, which; is similar to
Antimonium tartaricum, and an inability to raise the same. It has been greatly praised in catarrhal
pneumonia of young children where there is plentiful secretion and inability to raise it. The right
lung is more often affected in cases calling for chelidonium.

(7) PULMONARY TUBERCULOSIS

Pulmonary tuberculosis (TB) is a contagious bacterial infection that involves the lungs. It
may spread to other organs.

=>Causes:
Pulmonary tuberculosis (TB) is caused by the bacterium Mycobacterium
tuberculosis (M. tuberculosis). TB is contagious. This means the bacteria is easily spread from an
infected person to someone else. You can get TB by breathing in air droplets from a cough or
sneeze of an infected person. The resulting lung infection is called primary TB.
Most people recover from primary TB infection without further evidence of the
disease. The infection may stay inactive (dormant) for years. In some people, it becomes active
again (reactivates).
Most people who develop symptoms of a TB infection first became infected in the past. In some
cases, the disease becomes active within weeks after the primary infection.
The following people are at high risk of active TB or reactivation of TB:

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• Elderly
• Infants
• People with weakened immune systems, for example due to HIV/AIDS, chemotherapy,
diabetes, or medicines that weaken the immune system.

=>Sign and Symptoms:

The primary stage of TB does not cause symptoms. When symptoms of pulmonary TB occur,
they can include:
• Breathing difficulty
• Chest pain
• Cough (usually with mucus)
• Coughing up blood
• Excessive sweating, especially at night
• Fatigue
• Fever
• Weight loss

=>Diagnosis:

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  tuberculin skin test
 AFB positive sputum,
 chest x-ray,
 CT scan, MRI.
Nonspecific test-

 increased ESR, mild lymphocytosis.

=>Treatment:
Treatment of TB uses antibiotics to kill the bacteria. Effective TB treatment is difficult,
due to the unusual structure and chemical composition of the mycobacterial cell wall, which
hinders the entry of drugs and makes many antibiotics ineffective. The two antibiotics most
commonly used are isoniazid and rifampicin, and treatments can be prolonged, taking several
months. Latent TB treatment usually employs a single antibiotic, while active TB disease is best
treated with combinations of several antibiotics to reduce the risk of the bacteria developing
antibiotic resistance.
People with latent infections are also treated to prevent them from progressing to
active TB disease later in life. Directly observed therapy, i.e., having a health care provider watch
the person take their medications, is recommended by the WHO in an effort to reduce the
number of people not appropriately taking antibiotics. The evidence to support this practice over
people simply taking their medications independently is poor. Methods to remind people of the
importance of treatment do, however, appear effective.
New onset
The recommended treatment of new-onset pulmonary tuberculosis, as of 2010, is
six months of a combination of antibiotics containing rifampicin, isoniazid, pyrazinamide, and
ethambutol for the first two months, and only rifampicin and isoniazid for the last four months.

74
Where resistance to isoniazid is high, ethambutol may be added for the last four months as an
alternative.
Recurrent disease
If tuberculosis recurs, testing to determine to which antibiotics it is sensitive is
important before determining treatment. If multiple drug-resistant TB (MDR-TB) is detected,
treatment with at least four effective antibiotics for 18 to 24 months is recommended.
Medication resistance
Primary resistance occurs when a person becomes infected with a resistant strain of
TB. A person with fully susceptible MTB may develop secondary (acquired) resistance during
therapy because of inadequate treatment, not taking the prescribed regimen appropriately (lack
of compliance), or using low-quality medication.
Drug-resistant TB is a serious public health issue in many developing countries, as
its treatment is longer and requires more expensive drugs. MDR-TB is defined as resistance to
the two most effective first-line TB drugs: rifampicin and isoniazid. Extensively drug-resistant TB
is also resistant to three or more of the six classes of second-line drugs. [92] Totally drug-resistant
TB is resistant to all currently used drugs. It was first observed in 2003 in Italy, [94] but not widely
reported until 2012, and has also been found in Iran and India. Bed aquiline is tentatively
supported for use in multiple drug-resistant TB.

Homoeopathic treatment for Tuberculosis

(1) Ammonium muraticum:

Has a coldness between the shoulder blades, and his symptoms may call attention to t
pthsis?

(2) PHOSPHRUS:
Also has a diarrhea, which may still further indicate it in the later stage of
tuberculosis, it shown by the intolerance of the rectum to the presence of the faces, as soon as
anything enters the rectum is expelled. Increased sexual desire in phthisis is also good symptoms
of phosphorus.

(3) CAL. PHOS.:

Scrofulous and fat. swelling of upper lip. Worse in air. oversensitive to pain.
Desire to smoked meat. Emaciation. evening rise temperature.

(4) CAL. CARB.:

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 In the treatment of tuberculosis, it is of paramount importance to administration
the proper basic constitutional remedy rather one direct to the isolated symptoms. Calcarea suits
pale, sallow nonresistant patient of leuco phlegmatic temperament, and those whose
constitution broken down by frequent and profuse menstruation or by frequent miscarriages.
Patient takes cold easily. The cough is loose and rattling. affect mainly on middle third of lung.
Tuberculosis in young girls specially of anemic type.

(5) SILICEA:
In suppurative stage of tuberculosis. Silicea is one of our principal remedies. , it is
indicated in low grade vitality. patient is very much chilly. It is an excellent constitutional remedy.
The cough first at dry, racking but afterward loosen, there is copious rattling in chest and
expectoration is offensive. There are large cavities in lung with profuse night sweat.

(6) TUBERCULINUM OR BACILLNUM:

These remedies have been used by many homeopaths for tuberculosis. Patient has
desire of open air. There is a weak heart and much palpitation. The sweat is worse at night and
morning. weak patient with debility and night sweat. It has sudden rush of blood to the chest.
expectoration is offensive and green.

(7) PHELLANDRUM :
Remedy which have very offensive expectoration. It is useful in last stage of
tuberculosis, but the expectoration is muco purulent in silicea. Diarrhea is also present.

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 (8) LUNG CANCER

Lung cancer, also known as lung carcinoma, is a malignant lung tumor

characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can
spread beyond the lung by the process of metastasis into nearby tissue or other parts of the body.
Most cancers that start in the lung, known as primary lung cancers, are carcinomas. The two main
types are small-cell lung carcinoma (SCLC) and non-small-cell lung carcinoma (NSCLC). The most
common symptoms are coughing (including coughing up blood), weight loss, shortness of breath,
and chest pains.

=>Causes:
 SMOKING
particularly of cigarettes, is by far the main contributor to lung cancer. Cigarette
smoke contains at least 73 known carcinogens, including benzo[a]pyrene, NNK, 1,3-butadiene
and a radioactive isotope of polonium, polonium-210. Across the developed world, 90% of lung
cancer deaths in men during the year 2000 were attributed to smoking (70% for women).
Smoking accounts for about 85% of lung cancer cases.
Passive smoking—the inhalation of smoke from another's smoking—is a cause of
lung cancer in nonsmokers. A passive smoker can be defined as someone living or working with
a smoker. Studies from the US, Europe and the UK have consistently shown a significantly
increased risk among those exposed to passive smoke.
Those who live with someone who smokes have a 20–30% increase in risk while
those who work in an environment with secondhand smoke have a 16–19% increase in risk.
Investigations of side stream smoke suggest it is more dangerous than direct smoke. Passive
smoking causes about 3,400 deaths from lung cancer each year in the USA.
Marijuana smoke contains many of the same carcinogens as those in tobacco
smoke. However, the effect of smoking cannabis on lung cancer risk is not clear. A 2013 review

77
did not find an increased risk from light to moderate use. A 2014 review found that smoking
cannabis doubled the risk of lung cancer.

=>Risk:

Graph showing how a general increase in sales of tobacco products in the USA in the
first four decades of the 20th century (cigarettes per person per year) led to a corresponding
rapid increase in the rate of lung cancer during the 1930s, '40s and '50s (lung cancer deaths per
100,000 male populations per year).
Cancer develops following genetic damage to DNA and epigenetic changes. These
changes affect the normal functions of the cell, including cell proliferation, programmed cell
death (apoptosis) and DNA repair. As more damage accumulates, the risk of cancer increases.

RANDOM GAS
Radon is a colorless and odorless gas generated by the breakdown of radioactive radium,
which in turn is the decay product of uranium, found in the Earth's crust. The radiation decay
products ionize genetic material, causing mutations that sometimes turn cancerous. Radon is the
second-most common cause of lung cancer in the USA, causing about 21,000 deaths each year.

asbestos
can cause a variety of lung diseases, including lung cancer. Tobacco smoking and
asbestos have a synergistic effect on the formation of lung cancer. [10] In smokers who work with
asbestos, the risk of lung cancer is increased 45-fold compared to the general population.
Asbestos can also cause cancer of the pleura, called mesothelioma (which is different from lung
cancer).

AIR POLLUTION
Outdoor air pollutants, especially chemicals released from the burning of fossil fuels,
increase the risk of lung cancer.

GENETICS

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 About 8% of lung cancer is due to inherited factors in relatives of people with lung
cancer, the risk is doubled. This is likely due to a combination of genes Polymorphisms on
chromosomes 5, 6 and 15 are known to affect the risk of lung cancer.

=>Pathogenesis:
Similar to many other cancers, lung cancer is initiated by activation of oncogenes or
inactivation of tumor suppressor genes. Carcinogens cause mutations in these genes which
induce the development of cancer.
Mutations in the K-ras proto-oncogene are responsible for 10–30% of lung
adenocarcinomas. About 4% of non-small-cell lung carcinomas involve an EML4-ALK tyrosine
kinase fusion gene. Epigenetic changes—such as alteration of DNA methylation, histone tail
modification, or microRNA regulation—may lead to inactivation of tumor suppressor genes.
The epidermal growth factor receptor (EGFR) regulates cell proliferation, apoptosis,
angiogenesis, and tumor invasion. Mutations and amplification of EGFR are common in non-
small-cell lung carcinoma and provide the basis for treatment with EGFR-inhibitors. Her2/neu is
affected less frequently. Other genes that are often mutated or amplified are c-MET, NKX2-1,
LKB1, PIK3CA, and BRAF.
The cell lines of origin are not fully understood. The mechanism may involve abnormal
activation of stem cells. In the proximal airways, stem cells that express keratin 5 are more likely
to be affected, typically leading to squamous-cell lung carcinoma. In the middle airways,
implicated stem cells include club cells and neuroepithelial cells that express club cell secretory
protein. Small-cell lung carcinoma may be derived from these cell lines or neuroendocrine cells,
and may express CD44.
Metastasis of lung cancer requires transition from epithelial to mesenchymal cell type.
This may occur through activation of signaling pathways such as Akt/GSK3Beta, MEK-ERK, Fas,
and Par6.

=>CLASSIFICATION:

=>Sign and Symptoms:

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 Respiratory symptoms: coughing, coughing up blood, wheezing, or shortness of breath
• Systemic symptoms: weight loss, weakness, fever, or clubbing of the fingernails
• Symptoms due to the cancer mass pressing on adjacent structures: chest pain,
bone pain, superior vena cava obstruction, or difficulty swallowing
If the cancer grows in the airways, it may obstruct airflow, causing breathing
difficulties. The obstruction can lead to accumulation of secretions behind the blockage, and
predispose to pneumonia.
Depending on the type of tumor, paraneoplastic phenomena—symptoms not due to
the local presence of cancer—may initially attract attention to the disease. In lung cancer, these
phenomena may include hypercalcemia, syndrome of inappropriate antidiuretic hormone
(SIADH, abnormally concentrated urine and diluted blood), ectopic ACTH production, or
Lambert–Eaton myasthenic syndrome (muscle weakness due to autoantibodies). Tumors in the
top of the lung, known as Pancoast tumors, may invade the local part of the sympathetic nervous
system, leading to Horner's syndrome (dropping of the eyelid and a small pupil on that side), as
well as damage to the brachial plexus.

=>Diagnosis:

Performing a chest radiograph is one of the first investigative steps if a person reports
symptoms that may suggest lung cancer. This may reveal an obvious mass, widening of the
mediastinum (suggestive of spread to lymph nodes there), atelectasis (collapse), consolidation
(pneumonia) or pleural effusion. CT imaging is typically used to provide more information about
the type and extent of disease. Bronchoscopy or CT-guided biopsy is often used to sample the
tumor for histopathology.

=>Treatment:

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 Lung cancer treatment with surgical and allopathic mode of treatment – Mainly include
surgery, Radio therapy, immunotherapy and chemotherapy.

Homoeopathic Treatment for lung Cancer

(1) Calcarea fluorica:

This homeopathic remedy for cancer is most useful for knots, kernels or hardened
lumps in the female breast, accompanied with indurated glands of stony hardness; the
enlargements may occur in the fasciae. It will prevent the development of cancer, and should be
considered always in the cases where the breasts present suspicious lumps.

(2) Lapis albus:

Several cases of incipient scirrhus (cancer) of the breasts, presenting retraction of
the nipple, and the other characteristic symptoms have been cured with this remedy. It is of
signal use in many cases of goiter. Dr. E. G. Jones recommends Lapis in malignant diseases of the
uterus where the discharges are black and offensive and intense burning pains all through the
diseased part.

(3) Silicea:
This remedy will often abate the pains of cancer. Lupus and sarcoma Silicea with
a thick yellow and offensive discharge.

(4) Conium:
Great hardness of the infiltrated glands, with flying stitches in them worse at night.
Cancer, mammary tumors of beginning of scirrhus; chief remedy, especially useful after
contusions and bruises, it corresponds particularly to glandular bruises. Here it is an absolute
specific, and the writer advises the 30th potency. Dr. O. S. Haines has verified this statement. The
irritability seems the characteristic.

(5) Arsenicum:
This homeopathic remedy corresponds to the general phenomena of the cancerous
diathesis, though Bayes notes that we have other remedies which may possess more power over
cancer indicated. It is said to be almost a specific for lupus, and its special indications in any form
of tumor, be it cancer or not, the sharp burning and lancinating pain, the weakness and debility
and the general Arsenicum symptoms known so well. In other words, the patient is to be treated,
not the disease.

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(6) Hydrastis:
This remedy corresponds to what Jousset terms the epithelial diathesis and is of
undoubted and special value in epithelioma and uterine cancer. Our English confreres praise this
remedy in simple glandular tumors of the breast; here it allays the pain retards the growth and
improves the patient generally. The dyspeptic symptoms of the remedy lead to its choice. The
hydrastis treatment is one of the best known in cancer.

(7) Radium:
The use of this substance has been heralded as a homeopathic remedy for cancer.
Though it produces actually and pathologically that disease, it has never cured cancer in any
dosage nor in any stage of that affection. It uses in all doses save those of Homoeopathy is
dangerous and should be avoided. However, the excellent proving by Dieffenbach have
precisioned its use and it may have indicated therefore, not in Cancer, but in what Vannier so
happily the terms that “Cancerinique” dyscrasia, which means the abnormal blood conditions
which tend toward that disease, and always precede it.
Thus it uses is confined to the pregrowth manifestations when we have such
symptoms as aching pains, itching over the body, pains resembling a chronic arthritis.
Apprehension. Mentally tired and irritable patients. Pimples on the skin and spots which itch and
burn. Restlessness, heat in stomach, flatulence and constipation. The 30th potency is as low as it
should be used.
We can never be certain whether a patient has not been subjected in some
unknown way to radium emanations and by giving the remedy in the lower strengths we may
add to the trouble. A recent finding of the New York Health Department (April, 1932) says: “In
regions where radio-active minerals were mined an increased incidence of cancer, especially of
cancer of the lungs, had been noted.” It also condemned the use of so-called radium waters as
elements of danger.
A study of the “cancerinique’ or pregrowth symptoms will give positive
information as to the approach of this disease, and positive indications for the remedies that
should be used to prevent the same.

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 (9) PNEUMOCONIOSIS
=>Introduction:
Pneumoconiosis is an occupational lung disease and a restrictive lung disease caused
by the inhalation of dust, often in mines and from agriculture. In 2013 it resulted in 260,000
deaths up from 251,000 deaths in 1990. Of these deaths 46,000 were due to silicosis, 24,000 due
to asbestosis and 25,000 due to coal worker’s pneumoconiosis.

=>Types:
Depending upon the type of dust, the disease is given different names:
Coal worker’s pneumoconiosis (also known as miner's lung, black lung or anthracosis)
— coal, carbon
Asbestosis — asbestos
Silicosis (also known as "grinder's disease" or Potter's rot) — silica
Bauxite fibrosis — bauxite
Berylliosis — beryllium
Siderosis — iron
Byssinosis — cotton
Silicosiderosis — mixed dust containing silica and iron

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 Labrador lung (found in miners in Labrador, Canada) — mixed dust containing iron,
silica and anthophyllite, a type of asbestos
Stannosis — tin oxide
Pneumonoultramicroscopicsilicovolcanoconiosis — induced by ash from an erupting
volcano

=>Pathogenesis:
The reaction of the lung to mineral dusts depends on many variables, including size,
shape, solubility, and reactivity of the particles. For example, particles greater than 5 to 10 μm
are unlikely to reach distal airways, whereas particles smaller than 0.5 μm move into and out of
alveoli, often without substantial deposition and injury.
Particles that are 1 to 5 μm in diameter are the most dangerous, because they get
lodged at the bifurcation of the distal airways. Coal dust is relatively inert, and large amounts
must be deposited in the lungs before lung disease is clinically detectable. Silica, asbestos, and
beryllium are more reactive than coal dust, resulting in fibrotic reactions at lower concentrations.
Most inhaled dust is entrapped in the mucus blanket and rapidly removed from the lung by ciliary
movement.
However, some of the particles become impacted at alveolar duct bifurcations,
where macrophages accumulate and engulf the trapped particulates. The pulmonary alveolar
macrophage is a key cellular element in the initiation and perpetuation of lung injury and fibrosis.
Many particles activate the inflammasome and induce IL-1 production.
The more reactive particles trigger the macrophages to release a number of
products that mediate an inflammatory response and initiate fibroblast proliferation and
collagen deposition. Some of the inhaled particles may reach the lymphatics either by direct
drainage or within migrating macrophages and thereby initiate an immune response to
components of the particulates and/or to self-proteins that are modified by the particles. This
then leads to an amplification and extension of the local reaction.
Tobacco smoking worsens the effects of all inhaled mineral dusts, more so with
asbestos than with any other particle.

=>Diagnosis:
Positive indications on patient assessment:
Shortness of breath
Chest X-ray may show a characteristic patchy, sub pleural, bibasilar interstitial infiltrates or small
cystic radiolucencies called honeycombing.

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Pneumoconiosis in combination with multiple pulmonary rheumatoid nodules in rheumatoid
arthritis patients is known as Caplan's syndrome.

=> Pulmonary fibrosis:

Inhalation of coal dust, cotton fibers, certain types of fungus spores, and many other
substances attending certain occupations also may cause pulmonary fibrosis.
Early pulmonary fibrosis is often asymptomatic. Symptoms of pulmonary fibrosis
include dyspnea (initially on exertion, then at rest in later stages.) cough, usually nonproductive,
chest discomfort/tightness, and fatigue. Clinical signs include crackles on auscultation of the
chest, usually at the lung bases and signs of pulmonary hypertension (if associated).

Diagnosis of pulmonary fibrosis

Laboratory tests – routine blood tests are normal. Blood gases may show hypoxemia.
Weakly positive titers of antinuclear antibodies and rheumatoid factor are present in a quarter.
Pulmonary function tests show reduction in all lung volumes with impaired gas transfer.
Chest X-ray – may show diffuse predominantly basal and peripheral ground glass change
with loss. Histological examination may show typical cellular infiltrate or fibrosis.

Homeopathic Treatment for Pulmonary Fibrosis

Homeopathy is one of the most popular holistic systems of medicine. The selection
of remedy is based upon the theory of individualization and symptoms similarity by using holistic
approach. This is the only way through which a state of complete health can be regained by
removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy
is not only to treat pulmonary fibrosis but to address its underlying cause behind pulmonary
fibrosis and individual susceptibility.
As far as therapeutic medication is concerned, several remedies are available for the
treatment of symptoms of pulmonary fibrosis that can be selected on the basis of cause,
sensations and modalities of the complaints. For individualized remedy selection and treatment,
the patient should consult a qualified homeopathic doctor in person. There are following
remedies which are helpful in the treatment of pulmonary fibrosis symptoms:
Arsenic Album, ipecac, Natrum Sulph, Phosphorous, Antim Tart, Cuprum Met, Nux Vomica,
Stannum Met, Causticum, Sepia, Silicea, Hepar Sulph, Lachesis, Kali Sulph, Kreosote, Arsenic
Iod, Kali Bi, Belladonna, Bryonia Alba, Rhus Tox, Tuberculinum .

85
(1) Beryllium:
Beryllium is indicated for people where there is formation of granulomas or nodules
that form in the lungs and may appear in other bodily systems and organs. Beryllium has been
found useful in the treatment of sarcoma in lung cancer. It is indicated for cases when the
individual has difficulty breathing and lung pain made worse when she moves. There may also be
a deep, dry cough and other respiratory diseases present, such as emphysema.

(2) Silicea:
Silica is indicated in cases of Fibroid development of the lung tissue is characteristic,
with thickening and scarring. The individual needing silica may be chilly, wanting to sit by the
heater for warmth. He may have an aversion to drafts, have cold hands and feet, have a lack of
appetite and experience mental prostration. The remedy may be helpful for relieving sharp pains
in the lungs, hemorrhaging in the capillaries and coughing with thick phlegm.

(3) Arsenic:
Breathing: asthmatic; must sit or bend forward; springs out of bed at night,
especially after twelve o’clock; unable to lie down for fear of suffocation; attacks like croup
instead of the usual urticaria.

(4) TUBERCULINUM BOVINUM:

Croupous condition of the larynx. Dryness in the air passages. Inflammation of the
larynx and trachea; much mucus in the larynx and trachea; spasmodic conditions of the larynx
like Laryngismus; burning rawness and soreness in larynx and trachea; phthisis of the larynx.
Inflammation of the bronchial tubes, stitching of the skin of chest; oppression of the chest and
heart in a warm room. Pain in chest on coughing; palpitation from excitement, from exertion.

(5) GRAPHITES:
Constriction of chest; spasmodic asthma, suffocative attacks wakes from sleep; must
eat something. Pain in middle of chest, with cough, scraping and soreness. Chronic hoarseness
with skin affections. Inability to control the vocal chords; hoarseness on beginning to sing and for
breaking voice.

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 DISEASE OF PLEURA

(10) PLEURISY
Pleurisy is an inflammation of the pleura, the membranes that line the thoracic cavity and
fold in to cover the lungs. Pleurisy may be characterized as dry or wet.

=>Causes:
Viruses are a common cause of pleurisy. They may cause the pleural membranes to
become inflamed and sore in the same way as they affect the membrane of the nose when a
person has a cold. Like any other sort of viral infection, pleurisy can occur in small epidemics.
Bacteria can also produce pleurisy, although they usually do this as a result of
underlying pneumonia. As infection spreads through the lung tissue, it eventually leads to
inflammation of the outer surface of the lung. This inflammation then leads to the symptoms of
pleurisy.
Another common cause of pleural effusion is cancer. Lung cancer as well as cancer
from other parts of the body can spread to the pleura. If the pleura is involved, the cancer usually
is inoperable.

=>Sign and Symptoms:

The defining symptom of pleurisy is a sudden sharp, stabbing, burning or dull pain in
the right or left side of the chest during breathing, especially when one inhales and exhales. It
feels worse with deep breathing, coughing, sneezing, or laughing. The pain may stay in one place,
or it may spread to the shoulder or back. Sometimes, it becomes a fairly constant dull ache.
Depending on its cause, pleuritic chest pain may be accompanied by other symptoms:

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Dry cough
Fever and chills
Rapid, shallow breathing
Shortness of breath
Tachycardia
Sore throat followed by pain and swelling in the joints.

=>Diagnosis:
A diagnosis of pleurisy or another pleural condition is based on a medical history,
physical examinations, and diagnostic tests. The goals are to rule out other sources of the
symptoms and to find the cause of the pleurisy so that the underlying disorder can be treated.
Physical examination
A doctor uses a stethoscope to listen to the breathing. This method detects any unusual sounds
in the lungs. A person with pleurisy may have inflamed layers of the pleurae that make a rough,
scratchy sound as they rub against each other during breathing. This is called pleural friction rub.
Diagnostic tests
Depending on the results of the physical examination, diagnostic tests are sometimes performed.
Chest x-ray
A chest x-ray takes a picture of the heart and lungs. It may show air or fluid in the pleural space.
It also may show the cause (e.g., pneumonia, a fractured rib, or a lung tumor) of the pleurisy.
Sometimes an x-ray is taken while lying on the painful side. This may show fluid, as well as
changes in fluid position, that did not appear in the vertical x-ray.
Blood test
Blood tests can detect bacterial or viral infections, pneumonia, rheumatic fever, a pulmonary
embolism, or lupus.
ECG
Electrocardiography test can determine if a heart condition contributes to the symptoms.
Ultrasound
Ultrasonography uses sound waves to create an image. It may show where fluid is located in the
chest. It also can show some tumors. Although ultrasound may detect fluid around the lungs, also

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known as a pleural effusion, sound waves are scattered by air. Therefore, an actual picture of the
lungs cannot be obtained with ultrasonography.
Computed tomography (CT) scan
A CT scan provides a computer-generated picture of the lungs that can show pockets of fluid. It
also may show signs of pneumonia, a lung abscess, or a tumor.
Magnetic resonance imaging (MRI)
Magnetic resonance imaging (MRI), also called nuclear magnetic resonance (NMR) scanning, uses
powerful magnets to show pleural effusions and tumors.
Arterial blood gas
In arterial blood-gas sampling, a small amount of blood is taken from an artery, usually in the
wrist. The blood is then checked for oxygen and carbon-dioxide levels. This test shows how well
the lungs are taking in oxygen.

=>TREATMENT OF PLEURISY:

The pain of pleurisy is controlled with acetaminophen, non-steroidal anti-inflammatory

drugs, or occasionally with narcotics, depending on the severity of the pain. Treatment of the
underlying cause of pleurisy is essential. Bacterial pneumonia is treated with antibiotics. Viral
infections are usually self-limiting and do not require medication other than symptomatic relief.
Thoracentesis is necessary if there is effusion in the pleura.

Homoeopathic Treatment for Pleurisy

(1) Belladonna:
Pleurisy of children in congestive types, often accompanied with convulsions, instead of fever
for the 1ststage, when fever and pain return inspire of Aconite.

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(2). Tuberculinum
For the 1st stage.
(i) Dry hacking cough,
(ii) Pains relived by bending forward. This remedy is next to Bryonia in severity and
intensity.

(3) Arnica: – Pleurisy due to external injury and after fever has abated. The pains still remain.
(4) Bryonia:
For the 1st stage. Dry pleuritis during pneumonia or phthisis. In other cases, it should
be given after exudation has set in and the fever has abated to same extent by Aconite. The
prominent symptoms are short stitching pains, worse from slightest motion; even breathing is
painful and the patient lies on the affected side to relieve this pain.

(5) Arsenicum: -
In serous pleurisy (2nd stage) for large accumulation of fluid; it often gives prompt
gives prompt relief to painful asthmatic respiration. There is great prostration.

(6) Hepar Sulph:

(3rd stage) in purulent exudation and in pleurisy complicated with bronchitis.

(7) Sulphur:
(i) Sharp stitching pain through the left lung to the back,
(ii) Worse lying on back and from the least motion. It follows Aconite and Bryonia
well, especially when chosen remedies fail to improve the patient.

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 (10) PLEURAL EFFUSION

=>Introduction:
A pleural effusion is excess fluid that accumulates in the pleural cavity, the fluid-
filled space that surrounds the lungs. This excess can impair breathing by limiting the expansion
of the lungs. Various kinds of pleural effusion, depending on the nature of the fluid and what
caused its entry into the pleural space, are hydrothorax (serous fluid), hemothorax (blood),
urinothorax (urine), chylothorax (chyle), or pyothorax (pus). A pneumothorax is the accumulation
of air in the pleural space.

=>Causes:
 Transudative
The most common causes of transudative pleural effusions in the United States are
heart failure and cirrhosis. Nephrotic syndrome, leading to the loss of large amounts of albumin
in urine and resultant low albumin levels in the blood and reduced colloid osmotic pressure, is
another less common cause of pleural effusion. Pulmonary emboli were once thought to cause
transudative effusions, but have been recently shown to be exudative.
The mechanism for the transudative pleural effusion is probably related to increased
permeability of the capillaries in the lung, which results from the release of cytokines or
inflammatory mediators (e.g. vascular endothelial growth factor) from the platelet-rich blood
clots. The excessive interstitial lung fluid traverses the visceral pleura and accumulates in the
pleural space.
Conditions associated with transudative pleural effusions include:

 Congestive heart failure

 Liver cirrhosis
 Severe hypoalbuminemia
 Nephrotic syndrome
 Acute atelectasis
 Myxedema
 Peritoneal dialysis
 Meigs' syndrome
 Obstructive uropathy
 End-stage kidney disease

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Exudative
Pleural effusion Chest X-ray of a pleural effusion. The arrow A shows fluid layering in the right
pleural cavity. The B arrow shows the normal width of the lung in the cavity
When a pleural effusion has been determined to be exudative, additional evaluation is needed
to determine its cause, and amylase, glucose, pH and cell counts should be measured.
Red blood cell counts are elevated in cases of bloody effusions (for example after heart surgery
or hemothorax from incomplete evacuation of blood).
Amylase levels are elevated in cases of esophageal rupture, pancreatic pleural effusion, or cancer.
Glucose is decreased with cancer, bacterial infections, or rheumatoid pleuritis.
pH is low in empyema (<7.2) and may be low in cancer.
If cancer is suspected, the pleural fluid is sent for cytology. If cytology is negative, and cancer is
still suspected, either a thoracoscopy, or needle biopsy [3] of the pleura may be performed.
Gram staining and culture should also be done.
If tuberculosis is possible, examination for Mycobacterium tuberculosis (either a Ziehl–Neelsen
or Kinyoun stain, and mycobacterial cultures) should be done. A polymerase chain reaction for
tuberculous DNA may be done, or adenosine deaminase or interferon gamma levels may also be
checked.
The most common causes of exudative pleural effusions are bacterial pneumonia, cancer (with
lung cancer, breast cancer, and lymphoma causing approximately 75% of all malignant pleural
effusions), viral infection, and pulmonary embolism.
Another common cause is after heart surgery, when incompletely drained blood can lead to an
inflammatory response that causes exudative pleural fluid.
Conditions associated with exudative pleural effusions:
After heart surgery (from incomplete evacuation of blood resulting in retained blood syndrome)
Parapneumonic effusion due to pneumonia
Malignancy (either lung cancer or metastases to the pleura from elsewhere)
Infection (empyema due to bacterial pneumonia)
Trauma
Pulmonary infarction
Pulmonary embolism

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Autoimmune disorders
Pancreatitis
Ruptured esophagus (Boerhaave's syndrome)
Rheumatoid pleurisy
Drug-induced lupus
Other/ungrouped
Other causes of pleural effusion include tuberculosis (though stains of pleural fluid
are only rarely positive for acid-fast bacilli, this is the most common cause of pleural effusions in
some developing countries), autoimmune disease such as systemic lupus erythematosus,
bleeding (often due to chest trauma), chylothorax (most commonly caused by trauma), and
accidental infusion of fluids.
Less common causes include esophageal rupture or pancreatic disease, intra-abdominal
abscesses, rheumatoid arthritis, asbestos pleural effusion, mesothelioma, Meigs' syndrome
(ascites and pleural effusion due to a benign ovarian tumor), and ovarian hyperstimulation
syndrome.
Pleural effusions may also occur through medical or surgical interventions, including the use of
medications (pleural fluid is usually eosinophilic), coronary artery bypass surgery, abdominal
surgery, endoscopic variceal sclerotherapy, radiation therapy, liver or lung transplantation, and
intra- or extravascular insertion of central lines.

=>Pathophysiology:
Pleural fluid is secreted by the parietal layer of the pleura and reabsorbed by the
lymphatics in the most dependent parts of the parietal pleura, primarily the diaphragmatic and
mediastinal regions. Exudative pleural effusions occur when the pleura is damaged, e.g., by
trauma, infection or malignancy, and transudative pleural effusions develop when there is either
excessive production of pleural fluid or the resorption capacity is exceeded.

=>SYMPTOMS:
You might not have any. You’re more likely to have symptoms when a pleural effusion is
moderate or large-sized, or if inflammation is present.
Shortness of breath
Chest pain
Fever
Cough

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=>DIAGNOSIS:
• Chest X-ray: Pleural effusions appear white on chest X-rays, while air space looks black. If
a pleural effusion is likely, you may get more X-ray films while you lie on your side. These can
show if the fluid flows freely within the pleural space.
Chest x-ray showing pleural effusion
• Computed tomography (CT scan): A CT scanner takes many X-rays quickly, and a computer
constructs images of the entire chest -- inside and out. CT scans show more detail than chest X-
rays do.

• Ultrasound: A probe on your chest will create images of the inside of your body, which
show up on a video screen.
• It can be used to locate the fluid so your doctor can get a sample for analysis.

=>Treatment:

Treatment depends on the underlying cause of the pleural effusion.

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 Therapeutic aspiration may be sufficient; larger effusions may require insertion of
an intercostal drain (either pigtail or surgical). When managing these chest tubes, it is important
to make sure the chest tubes do not become occluded or clogged. A clogged chest tube in the
setting of continued production of fluid will result in residual fluid left behind when the chest
tube is removed.
This fluid can lead to complications such as hypoxia due to lung collapse from the
fluid, or fibrothorax if scarring occurs. Repeated effusions may require chemical (talc, bleomycin,
tetracycline/doxycycline), or surgical pleurisies, in which the two pleural surfaces are scarred to
each other so that no fluid can accumulate between them. This is a surgical procedure that
involves inserting a chest tube, then either mechanically abrading the pleura or inserting the
chemicals to induce a scar.
This requires the chest tube to stay in until the fluid drainage stops. This can take days
to weeks and can require prolonged hospitalizations. If the chest tube becomes clogged, fluid will
be left behind and the pleurisies will fail.
Pleurodesis fails in as many as 30% of cases. An alternative is to place a PleurX Pleural
Catheter or Aspira Drainage Catheter. This is a 15Fr chest tube with a one-way valve. Each day
the patient or care givers connect it to a simple vacuum tube and remove from 600 to 1000 mL
of fluid, and can be repeated daily.
When not in use, the tube is capped. This allows patients to be outside the hospital.
For patients with malignant pleural effusions, it allows them to continue chemotherapy, if
indicated. Generally, the tube is in for about 30 days and then it is removed when the space
undergoes a spontaneous pleurisy.

Homoeopathic Treatment for Pleural effusion

(1) BRYONIA
This remedy suits most cases of pleurisy, and its symptoms picture this disease
more closely than any of our remedies. It should be given after the stage of exudation has arrived
and the fever has abated somewhat, though the fever may still be considerable. There are friction
sounds present and the great characteristic of sharp, stitching pains, which are worse from the
slightest motion; even breathing is painful and the patient lies on the painful side of lessen the
motion. “Dry” pleasure during pneumonia or phthisis.
It comes in after Aconite. Aconite. This remedy for the chills, high fever, sharply
defined chill; but it is only useful in the first stage before the exudation has taken place; there
may be sharp stitches in the chest from the intense congestion, but these, if marked, usually

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indicate Bryonia. An additional indication for Aconite would be in case the attack arose from a
chill following a checked perspiration. The good effects of the remedy are usually manifested
promptly. Ranunculus bulbous. Sharp, stitching pains in the chest, worse on the right side. It is
often found useful to absorb the effusion. Stannum.
Knife-like pains in the left axilla. Asclepius. Also a pleuritic remedy; there is a dry,
hacking cough, scanty expectoration, pains relieved by bending forward; the suffering is intense.
Hale says:” It seems to be a lesser Bryonia and is probably not adapted to serve cases.”

(2) BELLADONNA:
Pleurisy in children, of the congestive type, often ushered in by convulsions instead of
fever. Arnica. Pleuritis from external injury calls for Arnica. It is useful in traumatic and
hemorrhagic cases.

(3) Cantharis:
A palpitation valuable remedy in profuse sero-fibrinous exudations, is indicated by
dyspnoea, profuse sweats, weakness, tendency to syncope with scanty and albuminous urine.
Dr. Jousset accounts Cantharis a leading drug in pleurisy with effusion. It has caused this condition
in animals.

(4) Arsenicum:
Serous pleurisy; it oftentimes promptly relieves the painful asthmatic respiration and
favors absorption. It usually is a quick acting remedy. Arsenicum iodatum is suitable to
tuberculous cases and also Iodofor

(5) Apis:
Pleurisy with exudation, hydrothorax; a useful remedy in the stage of effusion after
the fever has abated and the pains have disappeared. Sulphur suits all forms of exudation; there
is a sharp, stitching pain through the left lung to the back, worse lying on back and from least
motion. It follows Aconite and Bryonia well.
It is one of our most valuable absorbents. Hepar. Purulent exudation; also an excellent
remedy in pleurisy complicated with bronchitis. It will hardly ever fail in plastic pleurisy when its
specific indications are present. It will often clear up cases of purulent pleurisy which tend to
induce consumption.

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