Symptoms of upper airway diseases:

• Sneezing / running nose.
• Nasal itching.
• Nose bleeds or epistaxis.
• Headache, “ blocked" / “stuffy” nose.
• “Phlegm” in throat need to clear throat frequently / “something stuck in throat”.
• Loss of sense of smell.
• Difficulty in swallowing.
• Pain in throat.
• Cough with / without “pleghm”.
• Stridor, a high pitched breathing sound that sounds like “ croaking”.

Symptoms of Lower airway diseases:

• Cough with or without “phlegm”.
• Breathing difficulties, limitation of physical activity and exercise capacity.
• Chest pains / chest “ tightness” or heaviness in chest.
• Noisy breathing or “wheezing” / whistling noises in chest.
• Coughing up blood or Hemoptysis.
• Hiccup.

You may experience one or more of these symptoms and some diseases are associated with certain patterns or groups of these symptoms.

For example, if you are coughing, wheezing, having chest tightness and breathing difficulties, these could be symptoms of asthma, especially if they come in episodes and are caused by known triggers (factors that aggravate asthma like allergens and irritants).

In addition, those with respiratory symptoms may have fever, body aches, poor appetite, loss of weight and symptoms related to other organ systems in the body depending on the underlying illness.  

Let’s now identify the various infections that your respiratory tract could contract:

Bronchiolitis:

Bronchitis is a chest infection that affects your large airways that carry air into your lungs as you breathe. These airways (bronchi) are part of your lower respiratory tract. Bronchitis is usually caused by a virus and often develops after a sore throat, cold or flu.The lining of your bronchi produce mucus to trap dust and other particles in the air we breathe. This helps prevent particles going into the lungs that cause irritation. During an infection, this lining becomes irritated and swollen (inflamed), producing more mucus than usual. Your body then tries to get rid of the mucus by coughing.

Common Cold:

Anyone can get a cold at any time and they are very common. Here’s a general idea of how many times you can catch a cold during the course of a year, based on how old you are:
-    Children, Adolescents & Teens can get about 5–10 colds per year
-    Adults can get 2–4 colds per year.

You could get more colds than adults because you are not immune to as many cold viruses as adults are.

What you need to remember is that a virus causes colds. There are about 200 different viruses that can cause a cold and each one is slightly different. That is why you can get one cold after another. Once your immune system has fought off an infection with one particular cold virus, you will be immune to that virus.

The cold is also called acute viral rhinosinusitis.

Cold symptoms can include:
-    A sore throat
-    Occasionally fever (a temperature of 38.5°C or higher)
-    Sneezing
-    A blocked or runny nose
-    A cough.

INFLUENZA/THE FLU:

The common cold is not the same as flu (influenza). Flu is caused by a completely different virus, and has much more severe symptoms, tending to last longer than a cold. However, the cold virus can still make you feel unwell and is usually more than just a runny nose.Flu (short for influenza) is a very common viral illness that can easily spread from person to person. The infection affects your nose, throat, bronchi (the two pipes at the end of the trachea that enter the lungs) and, occasionally, the lungs.Flu symptoms include:
•    Fever (i.e. a temperature of 38.5°C or higher), and chills
•    Headache
•    Runny or blocked nose and sneezing
•    Sore throat
•    Dry, chesty cough
•    Tiredness, aching muscles, and joint or limb pain
•    Loss of appetite, and upset stomach or diarrhea.

 

SEASONAL INFLUENZA:

Seasonal influenza is a serious viral infection caused by an influenza virus and can circulate across many parts of the world.

There are 3 types of seasonal influenza viruses, i.e. A, B and C. Type C influenza cases occur much less frequently than A and B. Type A influenza viruses are classified into subtypes according to the combinations of various viruses. Among many subtypes of influenza A viruses, influenza A(H1N1) and A(H3N2) subtypes are currently circulating among us.

Seasonal influenza is characterized by a sudden onset of high fever, cough (usually dry), headache, muscle and joint pain, depression, sore throat and runny nose. The cough can be severe and last as long as 2 or more weeks.

If you do contract seasonal influenza it is advised that you are incubated for a minimum of 2 days. When an infected person coughs, infected droplets get into the air and another person can breathe them in and be exposed. Hands contaminated with influenza viruses can also spread the virus. So remember to keep clean and away from others if you have contracted this.

In tropical regions, influenza may occur throughout the year, causing outbreaks more irregularly. Safe and effective vaccines are available and have been used for more than 60 years. Antiviral drugs for influenza are available and may reduce severe complications. As in most instances a case of the flu will resolve on its own and medication is not needed.Doctors may offer anti-viral drugs to certain patients if they are considered to be at risk of developing serious complications.

Pandemic Influenza:

This is an epidemic of the influenza virus and spreads on a global scale infecting a large proportion of the population.

In contrast to the regular seasonal influenza, these pandemics occur irregularly. Pandemics can also cause high levels of death. There have been about three influenza pandemics in each century for the last 300 years, the most recent one being the 2009 flu pandemic.

Influenza pandemics occur when a new strain of the influenza virus is transmitted to humans from another animal species, especially pigs, chickens and ducks.

These novel strains are unaffected by any immunity people may have to older strains of human influenza and can therefore spread extremely rapidly and infect very large numbers of people.

Influenza A viruses can occasionally be transmitted from wild birds to other species causing outbreaks in domestic poultry and could also cause a human influenza pandemic.

The spread of influenza viruses throughout the world is thought in part to be by bird migrations, though commercial shipments of live bird products and human travel patterns could also be causes.

To prevent the situation from progressing to a pandemic, the following short-term strategies have been put forward which include culling and vaccinating livestock, vaccinating poultry workers against common flu and limiting travel in areas where the virus is found:

 

A good public health communication strategy is required to tackle influenza pandemics. Here are some guidelines to follow:

1.    Social Distancing:
Traveling less, working from home or staying away from schools creates fewer opportunities for the virus to spread. While this is not entirely possible for a teenager who needs to be at school and other places, you could attempt to spend time in crowded settings when you can. It is also advised that you keep a physical distance between yourself and people who show symptoms of influenza-like illness, such as coughing and sneezing.

2.    Respiratory Hygiene
Always cover your mouth and nose when you cough and sneeze. If you are using a tissue to do this, remember to dispose of it carefully and clean/wash your hands immediately after.If you do not have a tissue handy when you cough or sneeze, cover your mouth as much as possible with the crook of your elbow.

3.    Hand-Washing Hygiene:
Frequent hand washing with soap and water (or with an alcohol-based hand sanitizer) is very important, especially after coughing or sneezing, and after contact with other people or with potentially contaminated surfaces (such as handrails, shared utensils, etc.)

4.    Other Hygiene:

Avoid touching your eyes, nose and mouth as much as possible. Any mask may be useful to remind the wearer not to touch the face. This can reduce infection due to contact with contaminated surfaces, especially in crowded public places where coughing or sneezing people have no way of washing their hands. The mask itself can become contaminated and must be handled as medical waste when removed.

LRTI refers to the inflammation of the airways/pulmonary tissue below the level of the larynx, due to viral, bacterial or fungal infection.

• Influenza - which can affect either the upper or lower respiratory tract.
• Bronchitis - infection of the airways.
• Pneumonia - infection of the lungs.
• Bronchiolitis - an infection of the small airways that affects babies and children aged under two.
• Tuberculosis - persistent bacterial infection of the lung.

A patient will present with symptoms such as cough, sputum production ,fever, chest tightness, wheezing and breathlessness.

Pneumonia

Pneumonia is an infection of the lung. Usually symptoms last for 3-4 weeks and are more common in very young children and elderly adults, but this doesn’t mean you can’t contract it as a teen. Pneumonia can be further classified as
•    Community-acquired pneumonia (CAP), which is contracted from coming into contact with the infection in daily life
•    Hospital-acquired pneumonia, which is contracted after a period of time in hospital

Common symptoms include cough, fever, sputum which may be blood stained, yellow or whitish in colour. Mild cases of pneumonia can usually be treated at home with antibiotics, ample rest and fluids.

Healthy teens will usually recover well. For people with other health conditions, pneumonia can sometimes be severe and may need to be treated in hospital. This is because pneumonia can lead to complications, some of which can be fatal, depending on your health and age. These include:
•    Respiratory failure due to the air sacs filling with fluid
•    Lung abscesses
•    Blood poisoning (septicemia)

Vaccinations are available against some strains of pneumonia and are especially recommended for those of your with weak immune systems.

Tuberculosis (TB):

TB is an infectious disease caused by bacteria called Mycobacterium Tuberculosis and was first described by Dr Robert Koch on the 24th of March 1882.Each year, we commemorate World TB on this day.

TB kills 2 million people globally each year. That is 5000 deaths a day globally! Virtually all TB deaths occur in the developing world, affecting mostly young adults in their most productive years. TB especially affects the most vulnerable, such as the poorest and malnourished.

Those with diabetes, chronic (long standing illness) of the lungs, kidneys, weakened immune systems by tobacco smoking, alcohol abuse and by the use of illicit drugs are at higher risk of becoming sick with TB. 

How you get TB disease?
TB is spread through the air from one person to another. The TB germs are passed through the air when someone who is sick with TB coughs, laughs, sings, or sneezes. If you breathe air that has TB germs, you may get TB infection. TB can cause death if not treated with medicine.

You wan’t get TB germs from:
-    Sharing drinking containers or eating utensils.
-    By shaking someone’s hand, sharing food, touching bed linens or toilet seats.

How does TB affect your body?
TB affects the lungs 80% of the time. It can also affect any organ system of the body. The most common organs involved are the lymph nodes, the outer covering of your lungs, the brain, the nervous system and the spine. It can also involve your kidneys, reproductive system, skin, bones, eyes and the pericardium, the outer covering of your heart.

When TB germ is inhaled into the lungs, the cells of the immune system try to contain it to that part of the lung only. However a few TB bacteria may escape in to the blood stream and/or the lymphatic system and travel to other organ systems of the body giving rise to disease of these organ systems. 

 What are the symptoms of TB, specifically in the lungs?

TB of the lung is called pulmonary TB.
•    A cough that lasts 2 weeks or longer.
•    Pain in the chest.
•    Coughing up blood or phlegm.
•    Weakness or feeling very tired.
•    Losing weight
•    Having no appetite.
•    Chills and fever.
•    Sweating at night or when you are sleeping

Symptoms of TB of other organ systems will depend on the organ involved.

How is Pulmonary TB diagnosed?
1.    Microbiological Diagnosis
This involves steps to identify the bacterium, making use of features that are specific to Pulmonary TB.

2.    Sputum Smear Examination
Pulmonary TB is diagnosed by examining a smear of coughed up phlegm from within the chest, under a microscope and the preparation of the smear for examination involves several steps.

3.    Sputum Culture
This is the “Gold Standard” for diagnosis and attempts to grow the bacterium in specially prepared chemical media, a process called culturing – you may have studies this in your science class already.

4.    Genetic Testing
Gene amplification techniques and genetic probes can be used to identify genetic sequences unique to mycobacterium tuberculosis. Genetic tests are expensive and are used only by those who have the expert knowledge about these.

5.    Chest Imaging
An X ray of the Chest may show features that suggest of TB. However other conditions of the lung such as other bacterial infections, lung cancers may show similar changes. Therefore doctors will also make attempts to use microbiological tests to arrive at a more definitive diagnosis. 6.    CT Scans
CT scans may also be of use but these must be supported by microbiological tests.

7.  Mantoux Test
The Mantoux (Tuberculin sensitivity Test)
This measures our immune systems response to a purified protein solution of the cell content of the TB bacteria which is injected under our skin The response is measured after 72 Hrs .
The transverse diameter of a swelling at the injection site is measured in millimeters.A measure of more than 10 mm is considered positive. 

A positive test may mean:
-    Past infection which is dormant or latent.
-    Past disease which has been cured .

BCG (Bacillus of Calmett and Guireine) vaccination.

Infection with other Mycobacteria that share common characteristics with Mycobacterium tuberculosis.

Current TB diseases but this has to be supported by other diagnostic and microbiological tests.

Those with a weakened immune systems may not show a positive response even when having TB disease.

• How is TB treated?
  TB can be completely cured if treated appropriately in the large majority of patients.
• The TB bacteria multiples slowly and has an outer covering called a cell which rich in fatty material.
• This enables the bacteria to escape destruction by our immune system. It also is able to undergo genetic modifications to avoid being killed by medication.
• Therefore we need to use several drugs and sometimes for long periods of time, ranging from 6-8 months to kill the majority of the bacteria and achieve cure.
• DOT or directly observed treatment is advisable in cases of TB for an effective cure.
• DOT is a strategy by which a health care provider observes the patient taking their TB medication.
• This ensures that the patient takes the TB medication in the right dose, at the right time for the right duration the medication is prescribed.Some versions of TB are resistant to medication.
• In these cases TB bacteria develops resistance by one or more medicines used to treat TB.
• This is a very dangerous situation as these patients need to be treated for more than two years with very strong medication with lots of side effects. Even after such treatment more than 50% of patients will fail to be cured.
• Laryngitis:

Laryngitis is an infection of your larynx, which results in a hoarse voice and difficulty speaking.

Your larynx is at the top of your trachea (windpipe) at the front of your throat, and contains your vocal cords.

The vocal cords vibrate and make sound when air passes through them. This is how you speak.

An infection of your larynx causes your vocal cords to become inflamed so that they cannot vibrate properly, which in turn affects your voice.

Pharyngitis (Sore Throat):

Common symptoms of a sore throat include.

Common symptoms of a sore throat include:
-    Redness and swelling (inflammation) at the back of your throat causing pain, especially when you swallow.
-    Red, swollen tonsils (the ‘glands’ at the back of your throat; tonsillitis)
-    Swollen ‘glands’ (lymph nodes) in your neck
-    Pain in your ears or neck.If your sore throat is caused by the cold or flu virus, you may also have some of the symptoms of a cold or flu including:
•    Fever (a temperature of 38.5°C or higher)
•    Headache
•    Runny nose
•    Cough
•    Tiredness
•    Aching muscles and limbs.

 

The ability of human lungs to function well is affected by exposure to pollution. This is mainly due to the pollution of the air.

Research over the past 10 years has shown that long-term exposure to even low to moderate levels of pollution is a risk factor for heart disease, asthma and other lung diseases.

The number of new cases of reduced lung function chronic bronchitis and asthma and COPD is directly related to how close people live to busy roads and to levels of chemical compounds in the air.

The researches shows the inhalable particles in the air to be of greatest concern of lung diseases.

A significant association was established between exposure to higher levels of PM10 in the air and the number of people developing COPD.

According to researches smoking is a major cause of COPD and other lung disease, being exposed to dirty air can result in a range of consequences that can exacerbate the problem.

The immediate effects range from irritations of the nose, eyes or throat; chest pain; coughing; digestive problems; dizziness; fever; lethargy; sneezing; shortness of breath; throat irritation and watery eyes, to a need for patients to increase their medication, a visit to their doctor, hospitalization and premature death.

The respiratory effects of air pollution depend on the type and mix of pollutants; the concentration in the air; the amount of time you are exposed to the pollutant; how much of the pollutant you breathe in; and how much of the pollutant penetrates your lungs.

Depending on their size, particles can be deposited in the upper airways (nose and throat), the large conducting airways and/or the small peripheral airways and air sacs or alveoli. At all of these locations, particles may produce irritation and inflammation.

Air pollution comes from transport, coal and other industrial power plants, industry, ships and from agricultural production, but also from natural sources such as wildfires.

Climate change  has an effect.

In addition, it appears that the allergic potential of pollen increases when linked to air pollutants.

It is not easy to predict who will be most affected.

However, children, older people and those with pre-existing conditions, including asthma, COPD and heart disease are at greater risk.

Genetic factors, infections and nutrition also play a role.

Outdoor Air Pollution

Outdoor air pollution is mainly due to small particles and ground level ozone that comes from car exhaust, smoke, road dust and smoke and chemicals pumping out from factories and power plants.

Not only that but also pollen from plants, crops and weeds also affect the quality of air.

Natural things like volcanic eruptions, wild fires, wind currents and trees can also contribute.

The pollution is high near busy roads, factories and where people burn things (bio masses).

Six common air pollutants:

• Ozone
• Particulate matter
• Carbon monoxide
• Nitrogen oxide
• Sulfur dioxide
• lead

Actions you can take to protect from polluted outdoor air:

• Monitor the air quality from local weather report.
• Remove indoor plants if they irritate or produce symptoms for you or your family.
• Filter the air coming into the home with the air conditioner.
• If you have asthma warning signs limit outdoor activity.
• When pollutants are high close your windows and stay inside.
• Avoiding outdoor activities near busy roads especially during rush hours. Outdoor activities should be done at times when the air quality is better.
• When walking or jogging or other sport consider alternative routes with lower levels of pollution.
• You should know when and where air pollution will be bad.

Indoor Air Pollution

What is Indoor air pollution ?

It refers to the physical, chemical, and biological characteristics of air in the indoor environment within a home, school building or other building.

Different conditions are responsible for indoor air pollution in the rural areas and the urban areas.

Rural areas and urban slums

In the developing countries, the rural areas and the urban poor  that face the greatest threat from indoor pollution.

Globally 3.5 billion people continue to rely on traditional fuels such as firewood, charcoal, household refuse , polytheen bags , plastic cups such as yoghurt cups for cooking.

Burning such fuels produces large amount of smoke and other air pollutants in the confined space of the home, resulting in high exposure.

Women and children are the groups most vulnerable as they spend more time indoors and are exposed to the smoke.

In 1992, the World Bank designated indoor air pollution in the developing countries as one of the four most critical global environmental problems.

Daily averages of pollutant level emitted indoors often exceed current WHO guidelines and acceptable levels.

Although many hundreds of separate chemical agents have been identified in the smoke from biofuels, the four most serious pollutants are particulate matter  (PM), carbon monoxide, polycyclic organic matter, and formaldehyde.

Urban areas

Exposure to indoor air pollution has increased due to a variety of reasons, including the construction of more tightly sealed buildings, reduced ventilation, the use of synthetic materials for building and furnishing and the use of chemical products, pesticides, and household care products.

Indoor air pollution can begin within the building or be drawn in from outdoors.

Other than nitrogen dioxide, carbon monoxide, and lead, there are a number of other pollutants that affect the air quality in an enclosed space.

kerosene

Volatile organic compounds (VOC)

VOC  originate mainly from solvents and chemicals.

The main indoor sources are perfumes, hair sprays, furniture polish, glues, air fresheners, moth repellents, wood preservatives, and many other products used in the house.

The main health effect is the imitation of the eye, nose and throat.

In more severe cases there may be headaches, nausea and loss of coordination.

In the long term, some of the pollutants are suspected to damage to the liver and other parts of the body.

 Tobacco Smoke

generates a wide range of harmful chemicals and is known to cause cancer.

It is well known that passive smoking causes a wide range of problems to the passive smoker ranging from burning eyes, nose, and throat irritation to cancer, bronchitis, severe asthma, and a decrease in lung function.

Burning of Mosquito coils , incense

Pesticides

Biological pollutants

Biological pollutants include pollen from plants,mite, hair from pets, fungi, parasites, and some bacteria.Most of them are allergens and can cause asthma, hay fever, and other allergic diseases.

Formaldehyde

Formaldehyde is a gas that comes mainly from carpets, particle boards, and insulation foam. It causes irritation to the eyes and nose and may cause allergies in some people.

Detergents

Asbestos

Asbestos is mainly a concern because it is suspected to cause cancer.

Radon

Radon is a gas that is emitted naturally by the soil. Due to modern houses having poor ventilation, it is confined inside the house causing harm to the dwellers.

Health Effects

• Respiratory Tract Infections
• Asthma
• Chronic Obstructive Pulmonary Disease (COPD)
• Lung cancer

Pigeon Breeding and Lovebirds - Pigeon / Bird Breeder’s Lung/ Bird Fancier’s Lung

Bird Fancier's Lung is a type of Hypersensitivity Pneumonitis caused by Bird Droppings.

The lungs recognize these bodies and react against for these foreign materials by initiating a granulomatous inflammation.This disease is caused by the exposure to avian proteins present in the dry dust of the droppings and sometimes in the feathers of some of birds such as pigeons, parakeets, cockatiels, shell parakeets budgerigars, parrots, turtle doves, turkey and chickens.But everyone who has birds does not get this disease because of the varying degrees of sensitivity in the people to these particles.In addition to that the birds do produce a dust that can trigger allergic reactions that include hypersensitivity pneumonitis, allergic rhinitis and some forms of asthma.

Sometimes these allergic reactions develop in people who have mild allergic reactions or no reactions at all as prolong exposure can increase the sensitivity to the bird dust.The disease can present as both acute and chronic forms .Depending on the onset the clinical symptoms vary.It can lead to serious injury to the lung; leading to fibrosis or scaring of gas exchanging surfaces of the lung.This can lead to respiratory failure and death.