Leading respiratory physician Dr Sujeet Rajan addressed questions from Seniors Today readers at the Health Live session on December 26. Dr Noor Gill captures key takeaways from the webinar
On Saturday, December 26, 2020 Seniors Today conducted a Health Live @ Seniors Today session with Dr Sujeet Rajan on Winter Coughs and Wheezes. Dr Sujeet Rajan is a leading respiratory physician in Mumbai, India. He graduated from the Grant Medical College in Mumbai in 1989 and postgraduated in respiratory medicine from the Seth GS Medical College and KEM Hospital, also in Mumbai in January 1994. He also holds a Diploma in Environmental, Tuberculosis and Respiratory Diseases from the CPS (College of Physicians and Surgeons) in Mumbai.
Following his postgraduation, Dr Rajan has been actively involved in research and clinical practice at the Bombay Hospital and Bhatia Hospital, both in Mumbai.
His areas of interest include interstitial lung fibrosis, airway disease, sleep disorders and end-stage lung disease. The research he has done has focussed around these areas, especially asthma, COPD and diffuse lung disease. He runs an ILD clinic with online MDD discussions.
Dr Rajan is also a postgraduate teacher at the Bombay Hospital. He was also the European Respiratory Society’s National Representative from India from 2015 to 2018. He is also the Indian Editorial Adviser for the American Journal of Respiratory and Critical Care Medicine, and has over 38 publications to his credit.
We started the session by asking Dr Rajan how things have been on his end given that he’s on the frontline in the Covid-19 pandemic. “Things are much better now. We are seeing fewer cases. We are seeing less panic than earlier. We are managing much more patients at home now, than we were earlier, which is a relief for the elderly patients. A large amount of common sense is coming; we are now following a more responsive than a reactive management of the situation,” he said.
– About 90-95% of Covid patients are going to have some abnormality on a CT scan. If you do a CT scan for every viral infection, you are sure to see some shadows and variability in the scan. Most of the patients with Covid are being treated without getting a CT scan, barring the patients who show a drop in the oxygen saturation levels later, to rule out clots in the lungs, lung fibrosis or for other complications in the lungs, otherwise you don’t need a CT scan. It is also a lot of radiation that you’re putting your body through. Dr Rajan recommends that you ask your doctor the indication and why they feel the need for the CT scan.
– A plain CT scan emits radiations that are equivalent to about 20 x-Rays. It’s not very high, the scanning time has also reduced, so if you ask a radiologist, they’ll tell you that the time of radiation exposure is not very high. But when you get 2-3 scans, the risk of carcinogenicity and risk of exposure increases multifold.
– Most of the oximeters bought from the market work well for about one year. They give accurate readings for about a year to a year-and-a-half. You will know that the oximeter has lost its efficacy when it either stops giving any reading or when the difference between two readings is fluctuating variably. The reading can also fluctuate if the finger is very cold, because that would mean that the peripheral circulation is not good. But otherwise, when you see varied readings in the same patient, the light is not coming on properly; the reading is taking too much to me to come, that is when you know that you might need a change of battery or device.
– The seasonal flu, which is common from the months of May to August, in Mumbai, was absent this year. There were hardly any patients with seasonal flu. We usually vaccinate the elderly patients, except that this year there was no seasonal flu, probably because people weren’t stepping out. As we’ve opened up, and people have started stepping out, the chances of one person catching the seasonal flu and transmitting it to many others increase. This can also exacerbate asthma, post viral bronchitis which can intensify lung disorders, if you have any.
– Covid and the seasonal flu are very different. Covid symptoms, barring the weakness and a little bit of sniffles, has very little similarity with seasonal flu. A patient with seasonal flu complaints of wheezing, they have chances of getting a post viral bronchitis. They also complain of runny nose, blocked nose and headache which Covid patients don’t present with. In fact, patients with Covid complaint of loss of smell, without a blocked nose.
– September to March is a season when allergic rhinitis plays up. Allergic rhinitis is like the asthma of the nose. You get swelling of your nasal passage. It can also be associated with nasal passage dripping and nasal blockage.
– For mild allergic rhinitis, you need an anti-histamine tablet. For persistent allergic rhinitis, nasal steroids are the treatment of choice. Take the lowest dose required for resolving the symptoms. Two squirt in each nostril at night to start off with. Followed by one squirt as it gets better. Furamist, Flomist, Metspray are some of the nasal corticosteroid brands. Nasal steroids are the most effective for persistent allergic cold/ rhinitis.
Anti-histamines can make you sleepy/ drowsy. If used regularly, they can also cause increase in weight, and in the elderly, it can cause urinary tract symptoms like dribbling of urine, difficulty in passing urine, so you have to be careful if they are being given regularly.
When do you need to use a nasal steroid to treat your cold? You need it when it troubles your work, sleep; for a child, it’ll be when it troubles his play or school.
One of the most common causes of cough in winters is allergic rhinitis with a post nasal drip. To avoid allergic rhinitis, you will have to find your irritants and avoid them. Dust is one such irritant. Try and reduces thick curtains and carpets. Keep books in closed cabinets. Wet mopping your room before you sleep should help. If you live in a humid area, a dehumidifier might help, but there is questionable evidence about that.
– Air purifiers that we normally get in the market that cost between Rs7000-15000 are not as affective. However, for patients who are more vulnerable for example patients with COPD, lung fibrosis, etc. and are uncomfortable when the air quality dips, can use them. But Dr Rajan says that they still do not filter bacteria, viruses and other microscopic pathogens effectively. The air purifiers that cost Rs 1 lakh and upwards, filter virus and bacterial pathogens very well.
– Steam does help a lot of people. Rhinitis concerns the nose, the sinuses drain in the nose. Sinuses are in the skull and this drainage makes the skull lighter. If you get rhinitis and blockage, the sinuses start filling up with fluid and you start feeling heaviness in your head, this condition is called allergic rhinosinusitis. What steam does is, it liquefies the fluid/secretions and makes it easier for it to come out. You can also substitute steam with hot fomentation. You can place a hot towel high up on your cheek bones, just below your eyelid and over your forehead- this is where the sinuses are.
Yes, steam can be harmful, here’s how:
– Steam is water, and water is not isotonic with our body fluids. Sometimes, when you take steam, it can irritate your nasal passage and cause sneezing or cough.
If the steam is very hot, it can burn your face.
- For Covid patients, please do not take steam inhalation in a room full of patients. Because the steam produces aerosol and vapours and someone else can contract Covid. Please take care of this otherwise as well, you could be a patient of Covid without the symptoms as well. We’ve been advising people to take steam with the door shut and windows open ideally.
- All asthma patients should keep a peak flow meter handy, and should keep checking your peak flow twice a day. You should repeat your lung function test at least once a year to see if your lung function has improved after going on the medication, or if it is the same even after going off the medication, if that is the case. The new guidelines suggest that even if you have been diagnosed with asthma, you should take Otrivin with a steroid – that is the new recommendation. We have an inhaler in India, for the same, it’s called Sterocort. For very mild asthma, there is Aerocort, which is a relief inhaler. If it gets persistent, you can use something stringer like Symbicort which you can also use SOS.
- Coming to the nose, the regular treatment is a nasal steroid. If it gets badly blocked, if you get an ear pain in a flight, you may want to use Otrivin for a few days, but not more than that. Regular use of Otrivin is harmful, in the sense that it will give you a phenomenal relief in hour symptoms for the time being but will cause rebound congestion. Otrivin contains a decongestant which can increase your pulse and your blood pressure, keep a watch on that as well.
Anyone who is coughing chronically, for more than eight weeks, there are three things that one would look at before referring them to a specialist.
- Post-nasal drip – this is one of the most common causes of chronic cough.
- Bronchitis or wheezing
- Acid reflux, after meals – having a late dinner, large meals, not exercising, can get the acid up to your throat thus causing the cough.
- As you grow older, your swallowing reflex grows weaker. So to take care of that, when you’re eating, you should keep your head slightly tiled downwards while swallowing. It can help in reducing the choking. There are some pharyngeal muscle exercises that a physiotherapist can guide you through to help you strengthen your swallowing reflex.
If you’re an asthmatic or have been one in the past, few things you can do to avoid its recurrence/exacerbation you should do the following things:
- Avoid smoking
- Avoid passive smoking
- Stay away from polluted air areas and environments, as much as possible
- Stay away from drugs that can cause exacerbation of your asthma, for example the beta blocker group of drugs.
- If you are an asthmatic mother and want to avoid disseminating it to their off spring, you should avoid caesarean section and continue breast feeding fir as long as possible.