A CME on “Changes in Pulmonology Clinic with Today’s Changing Environment” followed with Homoeopathy Panel Discussion was held at Max Super Speciality Hospital, Shalimar Bagh, New Delhi on 17 November 2024 as a collaborative CME by The Homoeopathic Medical Association of India, Delhi State Branch (HMAI Delhi) and Max Super Speciality Hospital, Shalimar Bagh, New Delhi.

There were detailed deliberations by

Dr Naveen Kumar Ailawadi, Consultant Pulmonology who deliver insightful keynote addresses on the latest trends in respiratory diseases and risk factors respectively.

The knowledge sharing session really took a great start, exploring the latest advancements in the pulmonology following by expert homeopathy panel discussion.

Below are some of the excerpts of discussion:

We need to be equipped with latest advancements especially in terms of investigations.
Our disease diagnoses should be the rapid and proactive as clinical conditions such as Pneumonia, Tuberculosis (TB), Bronchitis and Chronic Obstructive Pulmonary Diseases (COPD) are associated with multiple risk factors, co-occurring with other co-morbid conditions.
Cough with high fever should not allowed to go un-examined for longer duration
Till date Chest X ray is the preferred choice of investigation as the first line of investigation. It is easy, quick and can tell about lots of diseases. It should be appended with auscultation.
Hospital and Community acquired pneumonias still remains a nuisance for both patients and healthcare practitioners alike.
Bronco pneumonia is more dangerous than lobar pneumonia.
The CURB65 pneumonia scale (Confusion, Uremia, RR>30, BP – 90/60, AGE – > 65)
(as still used by many) comes with challenges such as wrong interpretation of scores obtained, absence of scoring based on saturation of oxygen reading (sPO2), pulse rate etc.
The latest score to assess Pneumonia is Pneumonia Severity Index – PSI
Confusion and use of ionotropes for BP in cases of Pneumonia and respiratory distress are the two absolute clinical indication for Intensive Care Unite (ICU) admissions
Increased value of lactate in blood is indicative of Sepsis
Antibiotic resistance is emerging as a global challenge – due to emergence of new strains of bacteria’s and viruses and overuse / misuse of antibiotics
For every drug to act a minimal inhibitory concentration (MIC) of the drug is important.
The true indication of Bronchoscopy is when targetted medicine does not impact the improvement in 48 hours.
Pneumonia and TB are many a times needs to be differentiated from each other.
COPD – Treatable, Manageable, Preventable but cant be cured fully as the changes in the COPD are irreversible.
Poorly controlled long standing Asthma leads to COPD
ABCD categorisation of COPD
There is a emerging technique called FOT – Forces Oscillometry to detect the changes in alveoli – to detect the changes in the early obstruction.
FeNO- fractional extraction of Nitrous Oxide is another common modality to cross very the Eosinophilia in the airways.
There is a risk of Angle closure glaucoma in patients who use the wrong technique of Neublization, therefore, it is advisable to teach the patients about these simple management techniques.
Steam with normal saline – should be use cautiously especially in cases of Dry cough as it may lead to bronco-spasm – with hypertonic saline.

Homeopathy Clinical Tips

Fear of Disease – Ars. alb, Phos
Anxiety about Health – Ars alb
Cough at night – Drosera, Hyos, Puls
Cough Before sleep – Lach, Spongia
Cough with disturbed sleep – Kali carb.
Cough in morning after waking – Bry, Coccus cacti, Lach.,
Wakes with cough – Lachesis
Cough after laughing – Spongia

For preventive aspects to tackle the issues related to pollution

Acid Sulph 200
Influenzinum
Musca domestica – house fly
Pothos
Histaminum
Ars alb
Tuberculinum – tendency for URTI

Some important indications of important remedies in Air Pollution related disorders (excerpt taken from the Article – Air Pollution and Role of Homeopathy from link – https://vividhomeopathy.com/airpollution/

Homeopathic medicines stimulate body’s inner strength and boost the immune system to work well i.e. to reduce the disease load and to improve the overall health.
The constitutional or individualized homeopathy is known to reduce to tendency to catch respiratory illnesses.
The prescription is dependent upon symptoms, signs, tendencies, history and causation.
The treatment can be curative, palliative or supportive depending upon state and staging of disease.
In every stage homeopathy has a definitive role to play.
Homeopathic medicines can be taken safely along with other/conventional medications (ADD-ON Therapy).
In addition to constitutional/individualized medicines, the following medicines are frequently used on the basis of causation and symptom similarity:

Allium cepa: Rhinitis, coryza copious, fluent, watery, acrid discharge; burning in nose, mouth, throat; violent sneezing; eyes red, burning with profuse, watery, bland lacrimation; headache, cough, hoarseness.

Ammonium carb: Complaints from fumes, charcoal fumes; emphysematous changes in lungs; frequent sneezing, profuse discharge from nose, burning like hot water; stoppage of nose at night, wake up from sleep; sensation of dust particles in throat; dry tickling cough; chokes; wheezing.

Arsenicum album: An important remedy that is used in majority of complaints incidental to air pollutants, e.g. conjunctivitis, rhinitis, asthmatic bronchitis, emphysema, lung cancer, leukaemia and other malignancies, etc; quick respiration; suffocation inducing cough; scanty, frothy expectoration; sneezing without relief; burning in eyes; burning pains all over.

Blatta orientalis: Complaints from fumes, coal dust, smoke; relieves bronchospasm, acts as expectorant; dyspnoea, oppression of breathing; cough, with thick and purulent sputum.

Bromium: Complaints from coal dust; allergy to dust; complaints of sailors who suffer from asthma when they go ashore, better on sea. Dry spasmodic cough, airway feels filled with smoke; difficulty in inspiring, as if breathing through sponge.

Carbo veg: Complaints from carbon gas, carbon monoxide, dust, smoke, fumes from incomplete combustion of fuels. Collapse from imperfect oxidation. Oppressed, quick respiration; air-hunger, longing for fresh air; wants windows open; long spasms of cough with weakness, wheezing, gagging.

Cassia sophera: Complaints from exposure to dust, smoke; asthma, dry cough, with pain in chest, irritation in throat, better warmth; expectoration thick, yellowish; worse during winters, change of weather.

Dulcamara: Ailments from changing, damp environment, foggy weather, cold damp conditions, air-conditioned rooms; dry, teasing, spasmodic cough; hoarseness; dyspnoea after physical exertion.

Euphrasia: Inflammation of the conjunctiva; profuse acrid lacrimation; profuse, fluent bland coryza, sneezing in morning; violent cough in day time, abundant expectoration; worse indoors, warmth; better in open air.

Lobelia inflata: Ailments from smoke, dust; emphysematous changes; extreme dyspnoea; cough with sneezing, gasping; scanty expectoration; extreme nausea and vomiting, cannot bear taste or smell of tobacco.

Natrum sulph: Ailments incidental to spring & rainy season; dyspnoea; coughs continuously, towards end hacks up thick, ropy, greenish mucus.

Pothos foetidus: Ailments from smoke, dust; great dyspnoea and cough, frequent sneezing, pain in throat and chest, anxiety, abdominal distension and tension, better in open air.

Phosphorus: An important remedy that may be used in majority of complaints incidental to air pollutants, e.g. conjunctivitis, rhinitis, asthmatic bronchitis, emphysema, lung cancer, leukaemia, and other malignancies, etc. Breathing anxious, panting, short, hurried, very much oppressed; tightness across chest; violent hard, dry, tight, racking cough in spasmodic paroxysms.

Plumbum metallicum: An important remedy for lead toxicity. Interference with homoeostasis, rapid reduction in number of red cells, with pallor, icterus, anaemia. Localized neuralgic pains, neuritis, paralysis, wrist drop; stinging and tearing in limbs, with twitching, numbness.

Sulphurous acidicum: Persistent choking cough with copious expectoration; hoarseness, constriction of chest, difficult breathing.

Sabadilla: Rhinitis, pharyngitis; violent spasmodic sneezing, abundant watery nasal discharge, itching and tingling in nose, redness and burning in eyes, lacrimation, frontal headache, dryness and irritation in throat.

Sambucus: Nasobronchial hypersensitivity; paroxysmal nightly suffocative attacks; nose stopped up at night, breath through mouth; cough deep, restlessness, profuse perspiration.

Sanguinaria can: Nasobronchial hypersensitivity, asthmatic bronchitis. Severe dyspnoea, constriction in chest, severe spasmodic cough. Expectoration of thick yellow mucus, dislodged with difficulty. Sneezing, profuse watery mucus from nose; sensitive to flowers, odours.

Spongia: Complaints from sudden change of atmosphere, smoke. Severe form of asthmatic bronchitis, with dryness of respiratory tract. Severe dyspnoea, with wheezing, suddenly wakes up at night with intense suffocation; respiration rapid, short.