Cochin Cardiac Club

Health Blog by Dr.Uday Nair




What Causes Breathing Problems?

There are many causes of breathing problems. Some people have difficulty breathing when they get a cold. Others have trouble breathing because of occasional bouts of acute sinusitis. Sinusitis can make it difficult to breathe for a week or two until the inflammation subsides and the congested sinuses begin to drain.
Many breathing problems are chronic or long-term. These common breathing problems include chronic sinusitis, allergies, and asthma. These problems can cause a host of symptoms such as nasal congestion, runny nose, itchy or watery eyes, chest congestion, cough, wheezing, labored breathing, and shallow breathing.
The nasal passage is a pathway for viruses and allergens to enter your lungs. So the nose and sinuses are often associated with many lung disorders. A sinus or nasal passage inflammation may trigger reflexes and cause asthma attacks. And the No. 1 trigger for asthma is allergies.
Majority  have hay fever or pollen allergies. And many suffer from asthma. Oftentimes, asthma and allergies occur together. When they do, they can make life miserable if left untreated.
Millions of people have breathing problems because of chronic obstructive pulmonary disease, or COPD, which includes emphysema and chronic bronchitis. Breathing problems may also stem from other serious problems such as lung cancer, tuberculosis, pneumonia, and lung disease related to HIV/AIDS.

Which Tests Are Used to Diagnose Breathing Problems?

Doctors diagnose breathing problems by performing a physical exam, taking a patient history and family health history, and using different tests. For instance, pulmonary function tests, also known as lung function tests, are frequently used to assess lung function in people with asthma. These tests include spirometry and a test known as methacholine challenge.
Spirometry is a simple breathing test. It measures how much air you can blow out of your lungs and how fast you can blow it. This breathing test is used to determine the amount of airway obstruction. A methacholine challenge test may be performed to help establish a diagnosis of asthma. Your doctor will know which test is best for your situation.
In some cases, the doctor may take an X-ray to see the structures inside your chest, including the heart, lungs, and bones. A chest X-ray is a good test to diagnose pneumonia. It can't, though, identify most breathing problems by itself. For some people with breathing problems, a CT scan of the chest is needed. This scan looks for any problems in the lungs. A CT scan uses X-rays and a computer to create detailed images.
If you suffer with chronic sinusitis, your doctor may order a special sinus CT scan. This scan will be used to evaluate your sinuses. Once the problem is diagnosed, your doctor may prescribe effective treatment to help resolve the breathing difficulty.

Can Allergy Tests Determine the Cause of Breathing Problems?

Allergy tests may help your doctor identify the cause of your breathing problems. There are several types of allergy tests your doctor might use. One of them is the prick technique. In this test, the doctor first puts a tiny drop of allergen on your skin. Then the doctor makes a puncture with a needle directly in the drop of allergen extract. If you are allergic to the specific allergen, your body will react to it by turning red at the site. You may also experience itching and swelling at the site of the allergen placement.
If the prick technique is negative, your doctor may inject the allergen extract directly under the skin using a syringe. Other allergy tests include:
  • the scratch test, which involves breaking the skin and then dropping the specific allergen into the site
  • allergy blood tests (called a RAST or radioallergosorbent test)
  • a challenge test, in which the doctor introduces tiny amounts of the suspected allergen by inhaled, oral, or other routes
These tests are used less frequently than the prick technique.
After performing allergy tests, your doctor may know what's triggering your breathing problems. Then the doctor will be able to treat your allergy symptoms more effectively.

How Are Breathing Problems Treated?

Substances that cause breathing problem are known as triggers. Avoidance of triggers is the No. 1 way to control allergies and asthma. As an example, wearing a dust mask when doing housework or yard work may cut down on your exposure to allergy triggers. Avoiding a furry pet, washing bed linens at least once a week, and staying indoors during peak pollen times may also help prevent serious problems if you have allergies.
Medications are also important in treating breathing problems. Allergy drugs such as antihistamines and decongestants can make it easier to breathe for some people. These medications can be delivered orally or through inhalers.
In addition, inhaled steroids may give relief to some with chronic allergies and sinusitis. These drugs work to reduce inflammation in the airways. Allergy shots are yet another way to reduce sensitivity to allergens and may give relief to some breathing problems.
Asthma is treated with inhaled or oral drugs that help open airways and reduce the primary inflammation in the airways. These asthma medications help ease or even block airway obstruction and excessive mucus production. People with asthma must control inflammation in order to keep the airways open and reduce sensitivity to asthma triggers. Asthma triggers may include:
  • Viral infections (cold or flu)
  • Pollen
  • Pet dander
  • Mold spores
  • Dust mites
  • Cockroaches
  • Irritating pollutants in the air
  • Fragrances and fumes
  • Smoke
Even exercise can be an asthma trigger in some people.

Metered Dose Inhalers (MDIs): How to Use One When You Have COPD

People who have chronic obstructive pulmonary disease (COPD) or certain other lung conditions often take their medications using devices called a metered dose inhaler (MDI) or a dry powder inhaler (DPI).

What is a metered dose inhaler?

A metered dose inhaler is a handheld device that delivers a specific amount of medication in aerosol form, rather than as a pill or capsule. The MDI consists of a pressurized canister inside a plastic case, with a mouthpiece attached. With an MDI, you press on the device while inhaling the COPD medication directly into your lungs. Its portability makes it easy to use anywhere, anytime. MDIs use a chemical propellant to push medication out of the inhaler. 

What is a dry powder inhaler?

Some medications can be taken in the form of a dry powder, using a dry powder inhaler, which is also a handheld device. A DPI delivers medication to the lungs as you inhale through it. It doesn't contain propellants or other ingredients -- just your medication.

Why is it important to learn how to use my inhaler?

If you use the metered dose inhaler or dry powder inhaler the right way, you receive the right amount of COPD medication and it can reach deep inside your lungs. Then you can gain the full benefit of the medication. Also, if you use your inhaler the right way, you are less likely to experience side effects.

How do I use a metered dose inhaler?

These are the general steps for using a metered dose inhaler for COPD.
  1. Remove the cap from the metered dose inhaler.
  2. Shake the inhaler for a few seconds.
  3. Place your index finger on top of the canister and thumb on the bottom of the mouthpiece.
  4. Tilt your head back slightly and breathe out.
  5. Hold the inhaler upright about the width of two fingers from your mouth.
  6. Breathe in and out slowly through your mouth one time.
  7. Press down on the inhaler as you breathe in as slowly and deeply as you can - about 3 to 5 seconds.
  8. If possible, hold your breath for at least 10 seconds.
  9. If your doctor prescribed more than one puff of COPD medication, wait about 1 minute and repeat steps 2-8.
  10. Replace the cap on the metered dose inhaler.
  11. Gargle and rinse your mouth with water or mouthwash (usually advised only for steroid-type inhalers).

NEBULIZATION-Home Nebulizer Therapy

What is a Nebulizer?

A nebulizer changes liquid medicine into fine droplets (in aerosol or mist form) that are inhaled through a mouthpiece or mask. Nebulizers can be used to deliver bronchodilator (airway-opening) medicines such as albuterol (Ventolin, Proventil or Airet) or ipratropium bromide (Atrovent).
A nebulizer may be used instead of a metered dose inhaler (MDI). It is powered by a compressed air machine and plugs into an electrical outlet. Portable nebulizers, powered by an internal battery or cigarette lighter, are available for individuals requiring treatments away from home.

Nebulizer care guidelines

Your home care company will show you how to use the nebulizer. You will need the following supplies to give the nebulizer treatment:
  • Air compressor
  • Nebulizer cup
  • Mask or mouthpiece
  • Clean eye droppers or other measuring devices to dispense the medication

Treatment procedure

1. Place the air compressor on a sturdy surface that will support its weight. Plug the cord from the compressor into a properly grounded (three prong) electrical outlet.
 2. Wash your hands with soap and warm water, and dry completely with a clean towel.
3. Carefully measure the medicine exactly as you have been instructed. Use a separate, clean  measuring device (eyedropper or syringe) for each medicine. 
4. Remove the top part of the nebulizer cup, as shown to the left.
5. Place your medicine in the bottom of the nebulizer cup, as shown to the right.
6. Attach the top portion of the nebulizer cup and connect the mouthpiece or face mask to the cup.
7. Connect the tubing to both the aerosol compressor and nebulizer cup.
8. Turn on the compressor with the on/off switch. Once you turn on the compressor, you should see a light mist coming from the back of the tube opposite the mouthpiece as shown to the left.
9. Sit up straight on a comfortable chair.
10. If you are using a mask, position it comfortably and securely on your face as shown to the right.
11. If you are using a mouth piece, place it between your teeth and seal your lips around it as shown to the left..
12. Take slow, deep breaths through your mouth. If possible, hold each breath for two to three seconds before breathing out. This allows the medication to settle into the airways.
13. Continue the treatment until the medication is gone (about seven to 10 minutes).
14. If you become dizzy or feel "jittery," stop the treatment and rest for about five minutes. Then continue the treatment, but try to breathe more slowly. If these symptoms continue with future treatments, inform your health care provider.
15. Turn the compressor off.
16. Take several deep breaths and cough. Continue coughing and try to clear any secretions you might have in your lungs. Cough the secretions into a tissue and dispose of it properly.
17. Wash your hands with warm water and soap, and dry them with a clean towel.

Care of Nebulizer

Cleaning and disinfecting your equipment is simple, yet very important. Cleaning should be done in a dust- and smoke-free area away from open windows. Here is how to clean your equipment:
1. After each treatment, rinse the nebulizer cup with warm water, shake off excess water and let it air dry.
2. At the end of each day, the nebulizer cup, mask, or mouthpiece should be washed in warm, soapy water using a mild detergent, rinsed thoroughly, and allowed to air dry.


There is no need to clean the tubing that connects the nebulizer to the air compressor.
Do not put these parts in the dishwasher.
3. Every third day, after washing your equipment, disinfect the equipment using a vinegar/water solution or the disinfectant solution your supplier suggests.
To use the vinegar solution, mix 1/2 cup white vinegar with 1-1/2 cups of water. Soak the equipment for 30 minutes and rinse well under a steady stream of water. Shake off the excess water and allow to air dry on a paper towel. Always allow the equipment to completely dry before storing in a plastic, zipper storage bag.

Compressor care
  1. Cover the compressor with a clean cloth when not in use. Keep it clean by wiping it with a clean, damp cloth as needed.
  2. Do not put the air compressor on the floor either for treatments or for storage.
  3. Check the air compressor's filter as directed. Replace or clean according to the directions from your equipment supplier.
  4. Always have an extra nebulizer cup and mask or mouthpiece in case you need it.
  5. Store your medicines in a cool, dry place. Check them often. If they have changed color or formed crystals, throw them away and replace them with new ones.
  6. All equipment for your nebulizer therapy can be obtained through your equipment supplier.

Unplug the compressor before cleaning it.

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