People ask me if there are any surgical options. Yes one can try a lung transplantation as one of the options provided many conditions are satisfied. Most of the surgeons are not very keen about lung transplantation as the results are not as rewarding as in COPD or cystic bronchiectasis.

My advise and opinion about this illness is now that many are getting to know about the disease they should find out ways and means to get to prevent this disease.Interstitial lung disease can be secondary to a systemic illness. This can also be caused by some drugs or dusts. They cause inflammation and scarring in the lungs that are permanent. Lung contains small sacs called alveoli that get thickened in ILD and the tissue surrounding it also gets thickened and scarred causing permanent damage. Quitting smoking can prevent ILD from worsening. In other words prevention is better than thinking of cure. Respiratory disease is a silent killer unlike heart disease which makes a big noise and is treatable disease too by surgical means. There are no satisfactory and fool proof surgical methods to cure this disease.

Another very good option to slow down or retard this disease is use of oxygen. This method unfortunately is not liked by many. Many think resort to oxygen is last step or a step before. Contrary to this belief I must add nocturnal oxygen supplementation is one of the best methods of improving quality of life if started early.

All of us are aware of the other medications available for asthma. But the main line therapy for asthma is inhalers and to be specific steroid inhalers. If any other system is added to this group it is not harmful. But if a person is advised to stop inhalers and use only complimentary treatment it is suicidal.

There are many terms used to describe approaches to asthma care that are out side the realm of the optimum asthma care. Complimentary and alternative medicine is a group of diverse medical and health care systems, practices and products that are not presently considered to be part of the conventional medical practice. Some scientific evidence exists for some complimentary therapies but for most key scientific evidences are lacking. For example many believe that yogas will cure asthma. In reality it only compliments main line asthma therapy. Some of the mild asthmatics would improve very well. But there is no scientific data to say that yoga and exercise can replace treatment although enough data is there to prove that they can compliment each other.

This brings us to an important question of the difference between complimentary therapy and alternative therapy. Complimentary therapy is used along with routine treatment. Alternative treatment therapy is used as an alternative to conventional medicine. An example of this to use a special diet to cure cancer instead of chemotherapy or surgery.

Complimentary asthma therapy means that non-traditional treatments such as massage, yoga and similar treatments are employed. These treatments are used in conjunction with traditional therapies in most cases. These therapies compliment the use of prescription medication and other treatment provided by your medical doctor. Alternative therapy means that herbal and other natural treatments are implemented, often in place of traditional therapies. Sometimes, however, these alternative treatments are used along with traditional therapies just as in complimentary therapies.

At one time, complimentary and alternative asthma therapies were considered to be on the fringe and were frowned upon. Today these treatments are moving into the mainstream. Homeopathy, acupuncture, osteopathy and other treatments can be used to improve health and, in some cases, relieve asthma symptoms, reduce the frequency and severity of attacks and improve overall health. While your doctor may not suggest to you that you implement an alternative or complimentary therapy. If you are considering trying this type of treatments, talk to your health care provider. You may be surprised to learn your doctor is supportive of trying these treatments as long as you do not discontinue the traditional treatment modalities that have proven to be effective for you.

Learn everything you can about alternative or complimentary asthma treatments before trying any of them. Never stop taking prescription medication without the knowledge and advice of your medical care provider. There can be serious impacts such as increased frequency and severity of asthma attacks if you do not continue medication as advised by your doctor.

Asthma treatments are serious business. Each year people die because of asthma emergencies for which help is not sought quickly enough. Therefore, use common sense and a conservative thought process when deciding whether to try alternative and complimentary asthma therapies. If you do find that a companion therapy works well, such as yoga combined with traditional medicine or acupuncture in addition to physician’s treatments, then there is no reason to discontinue the alternative or complimentary treatments.

All of us are aware of the other medications available for asthma. But the mainline therapy for asthma is inhalers; to be specific, steroid inhalers. If any other system is added, it is not harmful. But if a person is advised to stop inhalers and use only complementary treatment, it is suicidal.

Many terms are used to describe approaches to asthma care outside the realm of optimum asthma care. Complementary and alternative medicine is a group of diverse medical and healthcare systems, practices and products that are presently not considered part of conventional medical practice. Some scientific evidence exists for some complementary therapies but, for most, key evidences are lacking. For example, many believe that yoga will cure asthma. But it only complements mainline asthma therapy. Some mild asthmatics may improve. But there is no scientific data to say that yoga can replace treatment although there is enough data to prove that they can complement each other.

Differences

This brings us to an important question: the difference between complementary therapy and alternative therapy. Complementary therapy is used along with routine treatment. Alternative treatment is an alternative to conventional medicine. Complementary therapy uses non-traditional treatment such as massage, yoga and similar treatments in conjunction with traditional therapy. These complement the use of prescription medication and other treatment provided by the doctor. Alternative therapy means that herbal and other natural treatments are implemented, often in place of traditional therapies. Sometimes, however, these are used along with traditional therapies just as in complementary therapies.

At one time, complementary and alternative asthma therapies were considered to be on the fringe and frowned upon. Today they are moving into the mainstream. Homeopathy, acupuncture, osteopathy and other treatment can be used to improve health and, in some cases, relieve symptoms, reduce the frequency and severity of attacks and improve overall health. While your doctor may not suggest an alternative or complementary therapy, if you are considering trying it, talk to your healthcare provider. You may be surprised to learn your doctor is supportive of trying these treatments as long as you do not discontinue the traditional treatment modalities that have proven to be effective for you.

Learn everything you can about alternative or complementary asthma treatments before trying any one. Never stop taking prescription medication without the knowledge and advice of your doctor. There can be serious impacts such as increased frequency and severity of asthma attacks if you do not continue medication.

Asthma treatment is serious business. Each year people die because of asthma emergencies for which help is not sought quickly enough. Therefore, use common sense and a conservative approach when deciding to try alternative and complementary asthma therapies.

If you do find that a companion therapy works well, such as yoga combined with traditional medicine or acupuncture in addition to physician’s treatments, then there is no reason to discontinue the alternative or complementary treatments.

Respiratory system is one of the organs that is not accessed easily any body. Even surgeons have their own reasons for not accessing it. Coronary by pass surgery, valvular replacements are more glamorous and sought after while surgery on lungs and mediastinum is not. This is probably because of the technical problems and the lack of people trained in this area. Physicians would not think of bronchoscopy as that involved a scope going in to an important organ and the patient also would think the same. In the process many treatable diseases were missed. Thanks to the awareness this scenario has changed. The last decade has seen many surgeons willing to go towards this field of lung surgery which is no long considered unsafe.

Another area that is not approached by physicians and chest physicians is mediastinum. Mediastinum is a cavity between two paired organs. Mediastinum contains all the principal organs of the chest except the lungs. It extends from the sternum or breast bone to the vertebral column and is bound laterally by pleura the layer that covers the lungs, pericardium the layer that covers the heart . Mediastinum is an imaginary part that houses heart, thymus. oesophagus, trachea ,bronchi, major blood vessels and nerves.

To have look into the mediastinum is only by means of chest xray, CT scans. But to get a tissue out of the chest diagnostic purpose was considered a difficult task. Only thoracic surgeons who were interested in this field used to do mediastiniscopy or mediastinotomy to get the lymph nodes, thymus and thyroid for diagnostic tissue. With the advent of interventional radiology the task became bit easier as these procedures did not involve any admission in to the hospital and were relatively safe day care procedures. The only concern about these radiological interventional were when the lesions were in mediastinum and were close to major blood vessels. In these situations there was no other option but to open and get the tissue for diagnosis.

In these circumstances ultrasound or sonar a radiological investigative tool comes in handy. The advantage of ultrasound is that it is real time. This means we can visualise the organs when we are accessing the organs. So the question or concern of hitting a blood vessel and causing damage does not arise. The ultrasound can be used on any organs superficial or deep to get the real time knowledge about the organs and also can used to map the tissue for interventional procedure. This property of the ultrasound is made use of in accessing the unseen parts in the chest especially lymphnodes that surround the major vessels and airways.

The history and birth of accessing the unseen parts of the chest goes to Japanese pulmonologists. Bronchoscope was one such great invention. The last two decade saw an explosion of the plethora of techniques that were used to get at lungs through this bronchoscope. Now we have a bronchoscope that is fitted with an ultrasound probe that can pick up lymph nodes in mediastinum. The birth of this Endobronchial Ultrasound (EBUS) was the result of the combination of the demand for a device that enables real time biopsy of the mediastinum and technology that has been developing over years in accessing the inaccessible.

Endobronchial Ultrasound also called EBUS can be used to aspirate the lymph nodes for diagnostic purpose, aspirate masses in the mediastinum and lungs that are close to airways and most importantly in lung cancer staging that would prevent unnecessary lung surgeries. This is done as a office procedure without any need for admission. This is just an extension of the bronchoscopy that has lots of potential not only to diagnose lung cancer but also stage the same that would help the physicians inplanning treatment strategies. This tool has been used across the world in many cancer centres to stage the lung cancer and in many centres this has become the first diagnostic step if one suspects cancer. Right now in India this is available in some centres and I am sure in years to come we will see more people trying to access the mediastinum that was considered the blind area of the radiologist and the pulmonologist.

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Following videos show a panel discussion on COPD  headed by Dr R Narasimhan.

Part I

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Part II

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Part III

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Part I

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Part II

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Part III

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