Respiratory Medicine

The Department of Respiratory Medicine was established in the year 1986. This department is affiliated to the Jawaharlal Nehru Medical College for undergraduate and Postgraduate teaching. This department has three flexible fibreoptic bronchoscopes, a well equipped Pulmonary function laboratory, Bronchoscopy, Thoracoscopy suite, sleep laboratory ventilators and blood gas analyzers besides other routine equipment. The department is situated in the First floor of the Hospital Building facing towards the Poona-Bangalore Highway. It is well ventilated, and has  four Consultant chambers. There are separate rooms to carry out various tests such as allergy skin test, Pulmonary Function tests with DLCO, Bronchoscopy, Thoracosopy, Pleural biopsy, Intercostal tube drainage, Lung biopsy etc., There is also a separate room for teaching the undergraduate and postgraduate students. The department has also got adequate space for the patients as well as the relatives of the patients to sit comfortably and discuss the modes of the management with the attending Consultant. There is a separate room for the recovery a patients and they can be kept for day care management purpose, specially after various procedures. Thus the patient can go home on the same day after any procedure.

Equipments:

The department has the following equipments namely,

  1. Fibreoptic bronchoscopy-three
  2. Pulmonary Function Test machine-two
  3. Mechanical Ventilators
  4. Allergy Testing kit
  5. Arterial Blood Gas analyser
  6. Pleural and Lung biopsy needles
  7. Rigid thoracoscope
  8. Level 1 Polysomnography system

 

Academic :

The department has been recognized by the MCI for conducting the postgraduate course and MD in Respiratory Medicine and is affiliated to the KLE University. The department has published more than 200 scientific papers in the National Medical Journals. The department has conducts many workshops for the Postgraduate students.

 

Health Education :

The department regularly conducted free health camps for patients suffering from respiratory disorders especially bronchial asthma and tuberculosis. Besides these, free smoking cessation clinics are being held regularly. The department is actively involved in the implementation of Revised National Tuberculosis Control Programme (RNTCP)  The department has conducted many workshops on RNTCP for the staff members, post graduates students, internees as well as for undergraduate students. Hence the department has been recognized as a Nodal center for RNTCP at J.N. Medical College, Belagavi.

 

Future Plan :

To set up a separate RICU, impulse oscillometry, Body Plethysmography, EBUS and Pulmonary rehabilitation center.

 

Allergy Testing :

Allergies, also known as allergic diseases, are a group of conditions caused by hypersensitivity of the immune system to substances the individual is exposed to in his surroundings. Allergies are common in people and are manifested as allergic rhinitis, food allergy, atopic dermatitis (Hives), asthma, and rarely Anaphylaxis. One of the allergy testing method i.e. Skin prick testing helps in determining the specific environmental / food allergen and thus helps in effective management of allergic diseases. Allergy testing can help confirm or rule out allergies. Correct diagnosis, counselling, and avoidance advice based on valid allergy test results reduces the incidence of symptoms and need for medications, and thus improves quality of life.

 

SKIN PRICK TESTING Skin prick testing is also known as "puncture testing" and "prick testing" due to the series of tiny punctures or pricks made into the patient's skin. Small amounts of suspected allergens and/or their extracts (e.g., pollen, grass, mite proteins, peanut extract) are introduced to sites on the skin marked with pen or dye. A small plastic or metal device is used to puncture or prick the skin. Sometimes, the allergens are injected "intradermally" into the patient's skin, with a needle and syringe. Common areas for testing include the inside of the forearm and the back.

 

Food allergy is very common in Indian population, and if it can be found at an early stage it can help in avoiding such food items and person can recover completely. Management of allergies typically involves avoiding what triggers the allergy and medications to improve the symptoms.

Allergen Immunotherapy Allergen immunotherapy is useful for environmental allergies, allergies to insect bites, and asthma. Its benefit for food allergies is unclear and thus not recommended. Immunotherapy involves exposing people to larger and larger amounts of allergen either by subcutaneous route or sublingual route in an affect to change the immune system's response. Meta-analyses have found that injections of allergens under the skin is effective in the treatment of allergic rhinitis in children and in asthma. The benefits may last for years after treatment is stopped. It also helps in reducing the use of other medications like inhaled corticosteroids in bronchial asthma.

 

Pulmonary function Test:

Pulmonary Function Tests (PFT) are a group of tests to measure the function of lung capacity and to evaluate the lung and chest wall mechanics to determine whether the patient has a respiratory problem.

From one expiratory forceful maneuver, we can calculate different values which varies from person to person: - Simple screening spirometry. - Lung volume and lung capacities estimation. - Diffusing capacity. - Airway resistance and strength of respiratory muscle. - Exhaled Nitric oxide estimation ( eN0 )DLCO is also routinely done for various types of lung disorders. It is best used in screening of any obstructive airway disease and restrictive disease of lung/chest wall. PFT has become a compulsory investigation prior to job applications in various industries and companies. Also it is an important test to evaluate patients prior to surgery, especially those with smoking history, elderly patients and those with known lung disorders. Children above the age of 4 years are eligible to perform this test.

Thoracoscopy :

Thoracoscopy is Procedure done to examine the chest cavity which is valuable for evaluation of any pleural pathologies. It is done using a Thoracoscope, which is a type of endoscope. It has gained much importance  since it is minimally invasive and has both diagnostic and therapeutic indications.

 

The Main users of this procedure are to

  1. Diagnose undiagnosed pleural effusions.
  2. Diagnosepleural pathologies.
  3. Obtain tissue samples from pleura, Mediastinum and pericardium.
  4. Remove small lung tumous.
  5. Drainfluidorpus form pleura.
  6. Adhesiolysis.
  7. Talc insufflation in cases of recurrent pneumothorax or malignant pleural effusions.
  8. Bullectomy.

This has helped a lot in improving the quality of life in terminally ill patients. This procedure can be done under local anesthesia and conscious sedation.

Polysomnography :

Polysomnography/sleep study is a multi parametric test used in the study of sleep as a diagnostic tool for sleep disorders.

* Indicated in patients with the symptoms of increased day time sleepiness, snoring  history of weight gain, choking episodes in the night, people who feel drowsy  during the day time /driving and meet with accidents.

* The study is usually performed over night in the sleep clinic under the supervision of sleep technician.

* PSG monitors many body functions which includes

  1. Brain (EEG)
  2. Eye movements (EOG)
  3. Muscle activity (EMG)

4.Heart  Rate is rhythms (ECG)

5.Level of snoring

  1. Thoracic and Respiratory movements.
  2. Oxygen level in the body (Pulse oximetry)

PSG is used to diagnose

Central sleep apnea

Obstructive sleep apnea

Obesity Hypoventilation syndromes

Periodic limb movement disorders

Restless leg syndrome

Narcolepsy

Parasomnial

Sleep disorders in cardiac patients

Sleep disorders in Diabetic patients

Video Bronchoscopy System

We are glad to inform that we have procured the most advanced Video Bronchoscopy System, in which we not only visualize the tracheobronchial tree for any abnormality, but it also has additional features of narrow band imaging (NBI) and High Definition Imaging (HD).

NBI is a new technology that enhances the visibility of vessels of the mucosa and also helps in differentiation between inflammation and pathological vascularisation of tumour. On the basis of morphology and frequency of vascular structures it is possible to differentiate malignant tissue and inflammation. It helps to assess the extent of Lung cancer, also helps in detecting recurrence after resection / chemotherapy. .

The advantage of bronchoscopy system is that it helps us in the diagnosis of difficult tuberculosis and diagnosis and staging of lung cancer. Bronchoscope play a very important role in the early diagnosis of the lung cancer and staging of the disease, since further management of the case depends upon the stage of the disease. It is also important as a screening tool for lung cancer specially in the elderly and patients with smoking history. Multiple procedures can be done with bronchoscopes-like foreign body removal, bronchial dilations for stenosis patients, cryotherapy, laser therapy and recently they are also being used for management of bronchial asthma patients by subjecting them for bronchial thermoplasty. One of the newer applications of bronchoscope is use of Doppler Ultrasound through the bronchoscope for evaluation of thoracic lymph nodes (Endobronchial ultrasound) and in placement of endobronchial valves in COPD patients to reduce breathlessness.