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Dr K K Aggarwal

Some tips to cope with high pollution levels

By Dr K K Aggarwal
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  1. Patients with asthma and chronic bronchitis should get the dose of their medicine increased during smog days.
  2. Avoid exertion in conditions of smog. It is better to avoid walking during smog hours.
  3. Drive slowly during smog hours.
  4. Heart patients should stop their early morning walk during smog hours.
  5. Remember to take the flu pneumonia vaccine.
  6. Keep doors and windows shut particularly during the early morning hours.
  7. It is better to wear protective masks if you must venture out.

Winter Asthma

By Dr K K Aggarwal
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Any breathlessness after the age of 40, appearing for the first time in winter, is cardiac asthma unless proved otherwise. Such patients should immediately have their blood pressure check-up done and if high needs immediate medical attention. First-onset breathlessness can also be an indication of angina or heart attack. However, the more common is winter asthma or acute exacerbation of winter COPD (chronic bronchitis). Asthma is reversible airway obstruction and COPD is irreversible airway obstruction. Sudden exposure to cold, humidity, pollution at lower levels in atmosphere can precipitate asthma in susceptible individuals. Winter is the time to increase the dose of asthma medicines.

If a person can speak a full sentence, the asthma attack is mild; if a person speaks broken sentences the asthma attack is moderate and if the person is able to speak only words then the asthma attack is severe. Severe attack of asthma needs immediate hospitalization.

Some tips to cope with the increased pollution levels.

By Dr K K Aggarwal
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Patients with asthma and chronic bronchitis should get the dose of their medicine increased during smog days. Avoid exertion in conditions of smog. It is better to avoid walking during smog hours. Drive slowly during smog hours. Heart patients should stop their early morning walk during smog hours. Remember to take the flu pneumonia vaccine. Keep doors and windows shut particularly during the early morning hours. It is better to wear protective masks if you must venture out.

Difference between fog and smog

By Dr K K Aggarwal
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Whenever the humidity is high air movement is less and the temperature is low fog is the automatic choice. It reduces visibility and more accidents are reported on the roads and delay in both railway and airlines services. When the level of pollution is high in the atmosphere the pollutant particles get mixed into the fog reducing its visibility further and the resultant is called as smog. Smog is very dangerous to both lungs and the heart. High sulfur dioxide contents lead to precipitation of chronic bronchitis. High nitrogen dioxide contents lead to precipitation of asthma. High particulate matter PM10 air pollutants sized between 2.5 to 10 microns can damage the lungs and precipitate asthma due to air flow and inflammation. High contents of particulate matter PM 2.5 air pollutants less than 2.5 micron in size can enter the lungs and damage the lung lining. They can also be absorbed and cause inflammation of the heart arteries. Patients with asthma and chronic bronchitis should get the dose of their medicine increased during smog days. Avoid exertion in conditions of smog. It is better to avoid walking during smog hours. Drive slowly during smog hours. Heart patients should stop their early morning walk during smog hours. Remember to take the flu pneumonia vaccine.

Who needs anti-viral drugs in swine flu?

By Dr K K Aggarwal
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Facts

1. In the United States, 0.3% of all cases require admissions.

2. The mortality rate of flu pandemic is 0.12 deaths per 100,000 population.

3. Total number of deaths caused by pandemic H1N1 influenza A in the United States was lower than the number of deaths caused by seasonal influenza during non-pandemic years 4. Early and prompt initiation of antiviral therapy is recommended for children, adolescents, or adults with suspected or confirmed swine flu with any of the following features:

o Flu requiring hospitalization

o Progressive, severe, or complicated flu

o Severely immunosuppressed patients (receiving treatment for malignancies, hematopoietic or solid organ transplant recipients)

o Swine flu at high risk for complications:

• Children <5 years particularly those <2 years

• Elderly =65 years

• Pregnant women

• Women up to 2 weeks postpartum

• Residents of nursing homes and other chronic care facilities

• Individuals with chronic medical conditions including: lung disease, including asthma (particularly if steroids have been required during the past year); heart disease, except isolated hypertension; active malignancy; chronic kidney disease, chronic liver disease, diabetes, sickle cell disease, other chronic disabling diseases and morbid obesity.

5. Severity of flu

o Asymptomatic swine flu: Many contact illnesses may pass off without symptoms. In all 19 percent had serologically confirmed infection and 28 percent of those who were infected may remain asymptomatic.

o Mild or uncomplicated swine flu (require no treatment, no hospitalization, no investigations)

• Fever, cough, sore throat, nasal discharge, muscle pain, headache, chills, malaise and sometimes diarrhea and vomiting

• No shortness of breath

• Little change in chronic health conditions.

o Progressive illness. Requires hospitalization

• Above symptoms plus

• Chest pain

• Poor oxygenation (high respiratory rate, hypoxia, labored breathing in children)

• Low blood pressure

• Confusion, altered mental status

• Severe dehydration

• Exacerbations of asthma, chronic bronchitis, chronic renal failure, diabetes, or other cardiovascular conditions

o Severe or complicated illness requires hospitalization

• Signs of lower respiratory tract disease

• Low oxygen requiring supplemental oxygen

• Pneumonia on x-ray

• Brain involvement

• BP lower than 80, organ failure

• Heart involvement

• Persistent high fever and other symptoms beyond 3 days