2 THE BREATHING SYSTEMWe hear of the first breath andthe last breath….Breathing is something, whichwe do the moment we areborn till the moment we die. So, what is this impor- tant thing called breathing? How does it happen? What in our body helps us to breathe? What are the illnesses that can affect our breathing? In this lesson, we will learn about organs that help us to
2-1 Our Breathing System nose throat voice box wind pipe bronchus lungsdiaphragm Organs in our body that help in BreathingStarting from the nose, the breathing system has organs likethe throat, voice box, windpipe and the entire lungs withthe small pipes to carry air within them. The sinuses are airpockets in the skull bones and also may be seen as part ofthe system. Let us see their roles one by one.
2-2 NOSE What is the nose made up of? The upper part of the nose is partially made of bone while the lower part is made of hard cartilage which is soft and moves when we press or pull it. The inside lining of the nose is very soft and delicate. This lining can produce sticky fluid, but much of such fluid also comes from the air sinuses in the bones – read below – around the nose that open into the cavity of the nose.What does the Nose Do? Why does our Nose leak?1. Our nose cleans the air we breathe in. It nose When the air is too cold or too hot,stands guard to see that the air that enters our body is the nose tries to bring out some stickydust free. Smal hair at the entrance of the nose filters fluid. The air that we breathe will have to pass through this fluid and hencethe dust from the air before allowing it to pass inside. its temperature will come closer to the body temperature. Too much of fluid2. Trapping Germs: The sticky fluid traps germs so may come out to make our nose leakthat it does not enter our lungs. or we sniffle.3. . It warms the air: Apart from cleaning the air, Also, when we have a cold lots ofthe nose also makes the temperature of the air accept- sticky fluid is produced. This helpsable to the body before it allows this air to reach our wash off the germs that might troublelungs. us if they got inside our lungs.4. Our nose helps us smell: The nose also helps us The sneeze reflex, an automatic reac- tion by which the nose throws out withto smell, a function that is more useful to the digestive great force what irritated it, also keepssystem, because it starts the regular digestive wave in harm away from the lungs.that system. You Cannot Cure A Cold ! A cold cannot be cured! There is no medicine made till date that can cure a common cold. Since it is due to an attack of a tiny germ – a virus – we should remember that the nose is trying to throw it out by bringing out a lot of sticky fluid or mucous. When we have a cold, instead of taking some tablets ot medicine immediately, we should take plenty of hot fluids and keep a cloth handy to wipe our nose. Some ‘cold medicines’ may bring relief from a bit of fever and headache, but are also likely to delay the cure !
2-3SINUSESWhy does your voice change whenever you have a cold?Sinuses are air pockets in the bones of our forehead and face -just above the nose and in our cheekbones. Like the nose, they sinusalso make sticky fluid to trap germs & dust. They give ahollowness to our voice when we talk. During a cold, thesesinuses fill up with a lot of sticky fluid. and changes our voice. What to do in Sinus Infection? Heaviness in the head, pain over the cheeks The biggest sinuses and a stuffy nose following a cold tell us are those inside our about the infection of the sinuses. To feel cheeks. The better, heat some water in a pan and breathe openings of these in its vaopur. sinuses are very high and it is Then, bend your head forward, tilt it to one difficult for them to side and blow firmly to empty the sinus. Do be emptied easily. the same on the other side. So, we get a feeling of heaviness around Take hot drinks like tea, coffee or soups. Inhaling vapour is the best our nose and below and cheapest remedy for most illnesses of the breathing system. our eyes when we have a cold.THROAT The ThroatThe throat starts from the end of the mouth and thenose till where the wind pipe and the food pipe begins.It also includes the voice box (the thing we can seefrom outside in our neck).The throat has a lining inside that is open to germs fromthe food and drinks we take, or from the air we breathe.For example, if we share food with a person who has asore throat, we are also likely to get a sore throat.Similarly, if someone has a bad throat (or even cough)in a crowded room, everyone sharing the air in thatroom is also likely to get the germs. tonsilsInfection of the throat leads to pain in the throat anddry cough. If the germs have infected the part joining throatthe food pipe, we are likely to find difficulty inswallowing. If it has infected the front part (the part Ask your neighbour to open herjoining the windpipe) or the voice box that has vocal mouth and ask her to saycords to bring out our typical voice – our voice is likely “aaaaaa………” . You can see most ofto change and we may also end up being voiceless. the throat including the tonsils
2-4 VOICE BOX The voice box or the larynx (la-rinks) is that portion of the front of our neck that juts out, and can be seen more prominently in men. The windpipe begins from just below this. The voice box has a fold of lining on either side that can stretch or relax. These folds – also called vocal cords by either stretching or relaxing – can make thedifference in our voice . The shape of the voice box and that of the foldsmakes our voice distinct from others. An infection of this area by germs,- bacteria or viruses – can cause swelling and pain and this may alsochange the nature of voice. If the swelling gets too much, it may result voice boxin a feeling of choking and breathing difficulty also. When you lose your voice ! We often see that people whose job depends on talking – such as teachers, lecturers or salesman lose their voice. This is because overuse causes strain on the voice box and we lose our voice. Severe infection of the voice box – or laryngitis – also make us lose our voice. We need to give the voice box as much rest as possible. Instead of forcing ourselves to talk, we can use slates and boards and sign language to get across what we want to say. Breathing vapour every few hours will also help. When the voice box has warmed up with hot vapour, we will need to retrain our vocal cords by trying to sing out aloud. For infections, along with breathing vapour, antibiotics may be necessary. WINDPIPE Knowledge You Can The windpipe – or trachea (tray- Use keah) - starts from below the If a sick person with voice box and ends where it breathlessness produces a divides into two bronchi (single- bronchus). You can see rings in sound, try to clearly make its entire length. These are bands out if the sound is of cartilage. They stop the produced while breathing in or windpipe from collapsing when breathing out. air is drawn in. Infections of the windpipe usually go along In swellings of the voice box and the with infections of the voice box. If the lining wind pipe, we may hear sounds while swells up, cough results. This cough is usually the person is breathing in air. But if dry. We may also feel breathless and a strange the sound is accompanied by sound is produced every time air passes through the windpipe blocked by the swollen breathlessness when breathing air out, and infected lining. the illness is clearly that of the breathing system below the windpipe!
2-5 BRONCHUS Bronchus is the pipe that carries air below the wind pipe right to the lungs. It branches left and right of the windpipe and ends into very tiny tubes inside the lungs. The bigger of these are called bronchi (brawn – kaai) and the smaller tiny ones are called bronchioles (brawn-key-oles). Each one is called bronchus (brawn-kus). Bronchus Lining Sweeping away the Germs The bronchus has a lining inside just The bronchus lining has tiny finger-like structures like the windpipe, and also has some which act like small brooms. They keep swaying smooth muscle in its wall. This muscle from one side to the other at all times. Just like the cannot be moved whenever we want, windpipe and the nose above, they also have sticky but squeezes or relaxes automatically fluid on it. Outside substances like soot, dust or when we breathe in or breathe out. germs stick to this. And in this swaying movement, The brain directly controls these the things that have stuck are handed over from muscles depending on how much of one finger like structure to the previous one and oxygen is required for the body. to the next previous one until they can be coughed out! Long-Standing Coughs When we are exposed to tobacco or other smoke for many years, the lining of our bronchus tends to lose its finger like structures and cannot produce sticky substance. As a result, outside dust and germs are no longer trapped and can cause their harm deep inside.This is what is called chronic(krau-nik) bronchitis or commonlycalled bronchitis. Smokers and old people have this more oftenand they lose their power – partially or fully - to resist outsideharm from germs. Hence it is important that such people help their breathingsystems in performing this task. To prevent further damage, these people shouldtake deep breaths of vapour coming out of water when heated – not boiled – everyday before they sleep in the night. Stopping smoking is obviously very, very important.
2-6LUNGSThe Lungs are the biggest and most important part of the breathing system. The two lungs are made of countless small round grape like structures, al- veoli. Through these, oxy- lungs gen coming in through our breathe is given to the blood in the capillaries. The grape like structures also allow carbon dioxide brought by the blood from the far off parts of the body to get thrown into the grape bronchi and later to be like alveoli breathed out of the system. These are pockets of air surrounded by the The diaphragm is a muscle tiniest of blood tubes called capillaries. between the chest and the ab- Diaphragm domen. It moves down- wards16 to 20 times a minute. When it is pulled down, air gets sucked into the lungs. When the diaphragm goes up, air is breathed out.Lungs are therefore the place where exchange happens. The blood capillaries have wallsthat have pores from where blood escapes and stale carbon dioxide gets exchangedwith fresh oxygen.Bronchus & BronchiolesThe lungs have many Protect children from lung infectionssmaller sections; Lung infections are the biggest cause of deaths amongeach called a lobe children below five and especially in babies less thanand supplied by one year. Poorly nourished, they cannot fight infections.small bronchi that Also, their bodies are too weak to cough out thebranch off inside to infections. We need to protect children from lung infec-smaller bronchi and tions.bronchioles. For every child who gets cough, we will have to see that she gets early treatment. But it is more important toUsually, in case of an prevent children from getting cough in the first place. Some of these wouldinfection, it is the en- protect children from getting lung - and some other common infections.tire lobe that getsswollen – inflamed – • We will have to see that they live in houses that areand the person can not crowded.get fever, cough and • Their houses should have enough windows to allow fresh airpain in the part of the • Make sure that we have toilets so that children do not step onchest. This is called eggs of worms when they walk around barefoot and get sick.pneumonitis or what • Children should get early treatment before they become toois commonly called weakpneumonia. to resist other diseases. • They should get extra food after every illness to help them recoverthe nourishment they lost by the previous one!
2-7 Know the Answers The Breathing SystemPlease fill in the Blanks:1. The main parts of the breathing system are _____________________, __________________, _____________________ , ______________________, and ______________________.2. The work of the breathing system is to ___________________________________________.3. How does the different parts of the breathing system defend itself from dust, diseases anddanger? a. Nose : _______________________________________________________________ b. Throat : ______________________________________________________________ c. Lungs: _______________________________________________________________ d. Bronchus : ___________________________________________________________4. Please mark whether the statement is “right” or “wrong”: a. The passge of the nose and mouth meets behind in the throat b. Lungs are connected to small air tubes that take oxygen to all parts of the body. c. When lungs breathe in air, the diaphragm is pushed downwards. d. The muscles in the bronchi can tighten suddenly to give asthma.
2-8 Diseases of the Breathing System What You Will Learn In This chapter Page Number1. Common Cold 2-9 to 2-102. Stuffy Nose 2-103. Coughs a. what are coughs? 2-11 b. types of coughs 2-12 c. treatment 2-134. Bronchitis 2-145. Asthma 2-156. Pneumonia 2-167. Learning to Count Breath 2-178.T. B 2-18 to 2-199. Allergy 2-2010. Ear & Its Problems a. Parts of Ear 2-21 b. Earaches & Infections 2-22 to 2-23 c. Deafness 2-2411. Throat Problems 2-24
2-9 DISEASES OF THE BREATHING SYSTEMThe breathing system from the nose to thelungs gives us trouble on a number of occa- General Principles to keepsions. From simple illnesses like cold and your Breathing System fitsneezing to serious ones like pneumonia and The lining of the breathing systemTB, we will try to learn more about them in is quite hardy. If it is kept intactthis section. and moist it can help us resist mostFor some diseases, we can follow some infections from viruses and bacteria.simple and cheap steps to cure them. In many This lining can produce a sticky fluidwe will learn to give medicines carefully. In that traps dust and germs. When thisothers we will learn to pick up the signals is produced in large amounts, it evenearly enough so that our friends and relatives acts as a filter to clean the air beforein the village can get cheap and affordable letting it get to our lungs.treatment for them in time. COMMON COLD A flowing nose and sneezing are signals that a cold has set in. The patients’ eyes may be red and bloodshot. The throat feels sore and a little dry cough may be present. Some may have slight fever or backache/pain in the joints. Different viruses bring on common colds and there is no vac- cine to prevent this commonest illness of the world. What to do in common colds? 1. Reassure the patient that it is a common illness and that the ill- ness will cure itself by the end of seven days. 2. Ask the person to drink plenty of hot fluids like tea and soups every few hours. You may add ginger and /or Tulsi (Basil) leaves to the tea. Orange or lemon juice are helpful. 3. Gargling with warm salt water may help to soothe the throat. Gargle with warm water 4. Vapour inhalation may be taken every few hours. 5. If the fever is too troublesome, you may give the person Tab PARACETAMOL or Tab ASPIRIN when re- quired or at most up to three times daily. 6. If the running nose is too much of a bother, one may add half to one tablet of Chlorpheniramine two to three times daily – but in children avoid it.
2-10 How can we keep the cold from spreading to others?Every time a person who has a cold breathes, sneezes or coughs, she (or he) throws outviruses and if another person breathes this in, this person will also take in the virus. Keep door and windows open when many people are sitting together, even if it is cold. The sick person should eat and sleep separately; he should cover his mouth and nose every time he sneezes or coughs. Eating and sleeping well builds up our resistance and prevents colds from attacking us. What NOT to do in a cold? DO NOT take any antibiotics for a cold as they are of no use and may cause harm. Colds always go away without medicines. DO NOT waste money on “cold tablets”, they are no better than Paracetamol or Aspirin! DO NOT blow the nose in a cold; wipe it clean – blowing may push the cold up the ear and sinuses and cause infection there. STUFFY NOSE A nose may get stuffy in the latter part of a cold or due to allergy. In children the mucus can be pulled out from the nose by a small dropper or a syringe (without a needle). For bigger children, plain or salted water can be sniffed into the nose. For those who usually get earaches and sinus problems after colds, one may use Tablets like Chlorpheniramine twice daily. Or they can use nose drops of salt water , which can be put into each nostril three times a day.
2-11COUGHYou saw earlier that cough is actually our friend. It is a way thebody defends us by trying to throw germs and infections out.Coughing should be encouraged rather than discouraged. Instead, we need to encourage cough that is wetter and has more fluid. The cheapest and simplest method is to inhale water vapour. Taking any medicine that dries the secretion or suppresses the cough actually helps germs to trouble us more. They stay in our organs longer and goes deeper to the inner parts. Scientists still debate if cough syrups are of any use at all. If at all one takes a cough syrup, see to it that it is marked EXPECTORANT. Avoid any cough syrup that contains cough suppressants like CODEINE, PHOLCODINE, DEXTROMETHORPHAN, etc. For children and the aged, these MUST NEVER be used! We Have More Breathing Dis- eases in Winters Inhale Vapour & Breathing diseases are more common in Cough it out! winters. This is mainly because we tend to huddle together in the cold and sit Heat some water – no need to boil closer to one another in closed rooms. it – until you can see vapour ris- ing from The chances of sharing our germs in such it. places become easier. It is better to keep doors and win- dows open at night and ask people to take an extra blan- B e n d ket to sleep while sleeping together in a room. Keeping over the doors and windows closed throughout the night will pre- pot, cover vent air circulation. It will increase the chance of spread- your head ing illnesses to another. with a towel or cloth, and inhale as Children’s Coughs deep as Children’s coughs and colds are possible usually due to viruses and there is several no effective medicine to kill these times. viruses. Vapour inhalation, good food and enough fluids make more The warm vapour will increase the sense than costly antibiotics. circulation of the lining inside and Antibiotics are necessary only if simple coughs and helps it to fight the germs. It also colds have not got better within seven or ten days or helps to make the cough more liq- the person has progressed to other diseases like pneu- uid so that it is easier to be coughed monia or TB (see later). out.
2-12Types of CoughsCough can be due to various reasons. When the air tubes or lungs get infected or when theyface dust, smoke or very hot or cold air, the body defends itself withcough to throw out the offensive germs or dust/gas.One should ask a person with cough about: 1. Does she have fever? 2. How long has she had the cough? 3. Is there any sputum? If yes, what is its colour? Is there any blood in the sputum? 4. Does the person feel very breathless also? 5. Has the person had such an illness earlier as well? Reasons for CoughsCough with breath- Cough for long Cough with blood:lessness and wheezing durations • TBsound: are suggestive of: • Pneumonia• Asthma • Smoker • Severe worm• Whooping • TB infectioncough/ diph- • Asthma • Cancertheria • Chronic Bronchitis • Heart failure • Heart trouble • Lung with pus pocketsDry Cough (without anyphlegm) Cough with Mucus• Cold • Bronchitis• Worms • Pus diseases of lung• Lung infection • Pneumonia like pneumonia• Measles Cough without fever can be be seen in: • Smoker’s cough • Allergy • Worms while passing • Chronic Bronchitis through lungs • Cancers • Cold • Rarely in TB • Asthma • Low fever may be present in TB
2-13 Different Coughs must be treated Differently1. For cough with blood Þ Check if the blood could have come from a bleeding gum or mouth injury. If there is irritation in the throat as well then bleeding is from the breathing system. The person needs to get checked for TB – an X-Ray, sputum examination and a doctor’s check up will help. • If a small quantity of blood comes out, it will stop on its own; • If it is less than 1 or 2 glasses, calm the person and rest him in bed.2. For severe dry cough 3. For cough with mucusWITHOUT PHLEGM that Þdisturbs sleeping and rest Loosen mucus by drinking lots of water or hot Þ Give Tablet or syrup fluids. This is the best - better than any medi- with CODEINE (but cine. not to the elderly and to children below ten Þ years!). You may give Breathe hot water vapours. Sit down or stand ASPIRIN next to a vessel with hot water. Cover yourself and the vessel with a sheet of cloth or towel so Þ Do not give it CO- that you can breathe the vapours. Breathe deeply DEINE if there is for 15 minutes. Repeat as many times a day as phlegm or wheezing possible. This is an excellent remedy for all res- sound while breathing piratory problems. in or breathing out. Þ You can tap the chest from behind for 10 to 15 minutes two times a day, especially for old and weak people. Treatment for all coughs Þ Grind some Tulsi (Basil) leaves to get a spoonful of juice. Mix with one spoon of honey and one spoon of lemon/orange juice. Give every two –three hours or so. Þ Give tea with ginger / tulsi leaves every few hours DO NOT ALLOW SMOKING.
2-14BronchitisBronchitis happens when the tubes going from the windpipedownwards to the lungs get infected. The person gets a noisy cough,usually with mucus or phlegm. The person also feels breathless.What to do in Bronchitis? 1. For adolescents & adullts, CIPROFLOXACIN may also be used. 2. Lower fever with cold compresses or PARACETAMOL; keep giving hot fluids and vapour inhalations. Bronchitis 3.Children’s bronchitis are mostly due to a virus. - noisy cough; breath- Antibiotics will not help. Only if the bronchitis lasts more than less a week and if it is not getting better, or if it is worsening to pneumonia, give antibiotics like COTRIMOXAZOLE or AMOXYCILLIN. What not to do How do we stop Bronchitis from in Bronchitis? spreading to others? Do not rush for 1. Ask the person to cover his mouth with his hand or handkerchief while antibiotics. coughing. DONOT allow 2. Collect the phlegm or mucus on a smoking. piece of paper and burn it or bury it well. Chronic Bronchitis Cough with mucus that occurs at least three months a year and keeps coming back every year is called Chronic Bronchitis (Kraw-nik Brawn-kai-tis). At times, especially in the winters, the cough may increase and the person may also have fever. If you can rule out TB or Asthma(see later), the person has Chronic Bronchitis. Usually seen in older people and those who have smoked heavily, it can lead to a disease of the lungs in which pockets of the lungs break down. In this disease, the person remains out of breath all the time. What to do in Draining Chronic Bronchitis? Out Phlegm Þ STOP SMOKING For old and weak Þ Take SALBUTAMOL three to four people, help with times a day. draining out the Þ Every time there is severe cough with phlegm and pus can fever, take antibiotic like be given. After in- COTRIMOXAZOLEor haling vapour, the DOXYCYCLINEor person should lie on AMOXYCILLIN his belly on a cot Þ Hot water vapours help a lot and and his chest and must be taken at least once a day, head must lean forward onto the ground hanging over especially at night. the edge. Tap on the back to loosen the mucus.
2-15ASTHMA Asthma AttacksThe muscle in the wall of the bronchi that must relax and squeezeand allow breathing may not do so because of some problems.A common problem that may occur is that the muscle may squeezetoo much. This causes breathing difficulty as the usual amount ofused air having carbon dioxide is not exchanged. This ailment isbronchial asthma or commonly called asthma (asth-mah).Sometimes, the muscles can squeeze all of a sudden and to suchan extreme that the person may no longer be able to breathe andmay even die.Asthma could be due to allergy when the lining of the bronchus in In Asthma attacks,the lungs reacts to some substances it comes in contact with. The the person findsallergy that causes asthma can be due to various things, like flower diffculty in breathingpollen, dust, cold air etc. What to do in Asthma? 1. Bring person to surroundings that are free of smoke, allergic things, etc. 2. If there is a chest infection, fever or the attack lasts more than three days, start Tablet COTRIMOXAZOLE twice a day. 3. Give lots of fluids to loosen the mucus. 4. For mild attacks, start SALBUTAMOL. If already on Salbutamol, the person may need an increased dose. 5. If the attack is severe. i.e., the person’s nails and lips look blue, RUSH HER TO A DOCTOR.How to prevent another Asthma attack? Avoid things that are known to bring attacks – for example, do not keep chicken or animals inside the house. Put bedding into sunshine regularly. If possible, sleep in the open. If the breathlessness is present all the time, keep the person all the time on SALBUTAMOL two times a day. If the person is known to get an attack following a cold or cough, tell the per- son to start on COTRIMOXAZOLE twice a day for seven days.
2-16PNEUMONIAInflammation of the lungs in response to infection or to harmful fumes andgases is called pneumonia. Like in all inflammations, the lungs too swell;there is pain, redness, heat and decreased functioning. It is quite commonin young children and in the aged.Pneumonia happens when we breathe in viruses and bacteria that other peopleare breathing or coughing out. Pneumonia is serious – it can kill! It is one ofthe largest killers of children and the aged. It needs to be identified early andtreated fast. Detecting Pneumonia How to know whether it isUsually affecting one part of the lung, pneu- common fever or pneumonia?monia should be suspected if a person has: Breathing becomes faster even with simple Cough, often with yellow, greenish or rusty, blood coloured mucus fevers. Therefore, it may be difficult, espe- High fever (fever may be low in cially with children, to say if the rapid elderly people) breathing is due to simple fever or due to Pain in some part of the chest, pneumonia, which also may give fever. especially while breathing deeply Difficulty in breathing, and To differentiate, one should count the Rapid shallow breathing breathing rate and the pulse rate at the same time. Normally, the pulse is about fourSigns of Serious Pnemonia times the breathing rate. If the ratio is lessAlong with the above: than four is to one, it is highly likely that* If the muscles between the ribs are drawn in (pulled the problem is not just simple fever, but ainwards) every time the child breathes problem with the breathing system, e.g.* If the person is unable to eat or drink. pneumonia.What to do in Pneumonia? Count breathing of babies1. Start COTRIMOXAZOLE or AMOXYCILLIN in full to detect pneumonia fast doses immediately. If serious, send for help, but after Pneumonia can kill babies very starting the treatment. fast. We should suspect2. Give PARACETAMOL if fever is high and to lessen pneumonia and start antibiotics pain. immediately if:3. Give plenty of hot fluids especially like tea, coffee or * A child less soups. If person is not eating, liquid foods or than one rehydration drinks may be important. month4. Get the person to breathe hot water vapour. Body breathes fiftydown shallow drainage may also help. breaths and more in a5. If the person is wheezing, SALBUTAMOL will help. minute. 6. Serious Pnemonia will need * If a child injcetions. Refer the person IM- who is between 1 month and 1 year old breathes forty MEDIATELY to a hospital ! shallow breaths and more in one minute.
2-17 LEARN TO COUNT THE BREATHA normal adult breathes about sixteen to twenty times every minute. But when thelung is diseased, as in the case of pneumonia, a person will have to breathe more ina minute. This is because only those parts of the lung that are not infected willwork well. And these parts may be unable to provide all the oxygen that the bodyneeds. Therefore, quicker and more breaths per minute tell us about a problemwith the breathing system.What we need to count is the breathing rate when the body is at rest. All that weneed to do is to look at the chest going up and down for a minute to count thebreathing rate. But it is not as easy as it seems. Most people will get conscious oftheir breathing when they are being watched. It will make them take deeperbreaths than usual, or hold back their breath for a second or two longer!The best time to count a person’s breathing rate is when she is sleeping. Butwhen sleeping, the movement of the chest is not so obvious. It would then help ifyou keep a piece of paper in front of the nose and count its movement each timethe person breathes out. Practise Counting Of BreathWe can count breathing in another way that would make the person less consciousthat you are actually counting her breath.Hold the person’s wrist and make it look as if you are measuring her pulse. Insteadyour attention should be on her chest and her breathing. By a side-glance you shouldbe able to count her actual breathing rate.Try this out with a partnerMake your partner lie down for about ten minutes (wewant the resting rate to compare with normal people).Tell the person that you are going to measure herbreathing rate. Keep an eye on your watch for a minuteand count the number of times the person has eithertaken in air or thrown it out. Note the figure.After a while, tell the person that you would like to checkher pulse, and by a side-glance count her breathing rate.Note it down and compare.
2-18TUBERCULOSIS (T.B)Tuberculosis or TB is a disease of the poor. Poor nutrition, bad housing and a lack of educationare the main reasons why TB is common in a community. It usually occurs in poor people orthose who do not get enough to eat and stay in houses that are crowded.In many rich countries,TB is no more a problem because people are less poor now, they have enough to eat, theirhousing standards have improved and education has been made freely available. How does T.B spread? TB may affect any part of the body, but usually it is seen in the lungs. A small but hardy bacterium called Mycobacterium tuberculosis is present in more than half the people of India beyond the age of forty. In some of those who have the infection, disease of tuberculosis may occur sometime during their lifetime. Less than half of all patients who have the TB disease and do not take any treatment may bring out the germ in their mucus. In damp atmosphere and in congested places, anyone nearby is likely to breathe in the germ and get infected. In those who are poorly nourished, the infection may lead to the disease.How does one recognise T.B?As TB can affect any part of the body, the general symptoms are: Low grade fever, especially rising in the evening Loss of weightThese are very commonsymptoms, but point towardsTB if they persist even afterthree weeks.As the breathing system is at-tacked by the bacterium inmost cases, any cough last-ing more than three weeksshould also make one sus-pect TB.TB can also happen in otherparts of the body. Apart fromfever and loss of weight, theperson may have smallglands in the neck (lymphglands), inability to bear chil-dren (ovary and tubes), lumpsin the abdomen (abdominalTB) or severe pain in the bigjoints.
2-19What to do for T.B?To all patient with symptoms of T.B, first give an antibiotic like COTRIMOXAZOLE for fivedays. If the symptoms continue:• Ask the person to collect the mucus (the fluid that comes with coughing) from his early morningcough and get a SPUTUM AFB test. A positive test means that the person has TB and is likely to spread it to other people with bacteria that are there in his mucus. • If the sputum test is negative, an X-ray may be necessary. Only doing an X-ray test without the sputum test may not help confirm whether there is T.B or not. If the person has T.B, medicines should begin immediately. As there are many schedules of different medicines that can be given for TB, request the treating doctor to start a schedule that the person can afford. Different types of drugs are of different costs and an affordable schedule is important. If the person starts and stops treatment repeatedly, the germ is likely to get resistant to the usual medicines. It is said that it is better not to treat a person’s TB than to treat halfway! The fastest course to treat T.B requires four drugs to be taken for two months followed by four months of two medicines only.The treatment is supposed to be got free from the government TB centre in the district headquarters.Public buses and trains allow free travel for such patients to collect their medicines every month. How do we stop T.B from spreading to others? ONLY a person with cough show- ing a positive result for TB can spread it to others. Those testing postive for T.B should: • Try to sleep in a separate room or if not possible then sleep in a room with open windows for ventilation T.B spreads through breathing and coughing. • Cover the mouth while coughing. Person with T.B should stay in separate room or a well ventilated room from family. • Do not throw away the mucus. Either bury the mucus in the ground or collect it on paper and burn it. People around the TB patient have a higher chance of getting TB. Hence, for the next two years the family members should also be under watch for the disease.
2-20ALLERGYThough not a disease of the breathing system, allergy is a reaction that occurs only in some peopledue to things that may be breathed in, eaten, injected or touched.Different people are allergic to different things. Commonly, some people react to pollen of someflowers and grasses, to some metals, small hair of house pets like cats and dogs, feathers of birds,small insects and some moulds that survive on blankets or carpets. Some people can react tothings they eat like rice, fish, beer, meat of cow or pig etc.People are also allergic to some medicines. Reactions to medicines like Penicillin and Sulphatablets are well known. Some Common Things that People develop Allergy Towards certain foods some drugs; sulpha; or penicillin injections animal feathers; fur plants or some herbs alcoholic some animals like drinks cats, dogs etc. old and mouldy blankets, pillows etcAllergy reactions can be mild What to do for Allergies?or serious: On the skin, the person may get 1. Try to find out rashes, or lumpy patches which drug or Some may get a stuffy nose and re- thing one reacts peated sneezing to and avoid Irritation in the throat, which may lead further to difficulty in breathing them. or an attack of asthma. Allergic shock — the person may col- 2. Tab CHLORPHENIRAMINE lapse and his pulse and BP may be very low. or PHENIRAMINE twice a Diarrhoea in some children, who day helps in reducing the react to milk or to wheat products. reaction.
2-21EarsEar complaints come second to complaintsabout the teeth whenever school children areexamined for health problems. Pus coming outof the ear again and again and ear ache arevery common.Ear structureThe ear has three parts. The outer ear hasthe ear canal and the pinna, the flap like piece that can be moved around in animals- andby some humans as well! – to the direction of the sound.The middle ear starts where the outer ear tube ends at the eardrum. The eardrum vibrateswith the sound waves and sends the vibrations through a chain of three very small bones.These vibrations are sent to a ear drum at the inner end of the middle ear. The middleear is also connected to the throat through a tube that helps to balance the air pressureon each side of the eardrum.The inner ear has the specialised snail shell. It is really special, for it is here that sound vibrationsreceived from the outer ear get changed into electrical signals. These signals when sent to thebrain help us understand the different sounds. The inner ear also has three half-circle canalsthat help us understand how our body is positioned. Signals from the half-half-circle canals inthe ears and signals from the eyes are jointly analysed by the brain to understand whether theperson is standing, lying or is unstable. Parts in The Human EAR Half Cirlcle Canals Pinna for balancing body Outer Ear Nerve Ear Canal Inner Ear - has snail shell; sends Ear Drum sound signals to brain; - outer Ear end has tubes which keep in ear drum Middle Ear body balance - from ear drum on- wards; has small bones; sends vibrations to inner ear; balances pressure on eardrums
2-22If something enters the earChildren may push foreign bodies inside their ears. Only ifthey are quiet and restful should one attempt to pull it out.It is always better to send the child for medical help wherethe child is given some medicine to sleep and then the foreignbody is taken out with special forceps.If an insect has gone in, it is important to kill the insect firstbefore trying to pull it out. Drop warm coconut or baby oilin the ear and then flush everything out with a syringe Children can be taught to check(without needle) with warm water. the ears of their siblings from time to timeEARACHE and EAR INFECTIONSAs said earlier, earache is very common, especially among children. Although earache is morecommon due to reasons in the outer ear, it may also be due to infections in the middle ear. Earwax, boils, a foreign body or a small injury while ’trying to clean’ the ear are the most commoncauses of earache. Sometimes, toothache and mumps may also appear like earache. Commonest Places of Ear Infections The ear tube from the middle ear to the throat is the commonest reason for infections reaching th ear. Especially during colds, if we pinch our nose and blow hard, the infection may travel into the middle ear. Here, there is limited space and if pus has formed, it tends to burst through the eardrum to the outer canal. If the hole in the eardrum is large, it may never heal and close. Infection can then reach it through water that enters accidentally while bathing or swimming. Repeated infections can spoil the small bones and the middle ear so that the sound from the outer ear is not transferred to the brain correctly. 1. Infection of Outer EarIf we want to know whether only the outer ear is infected, we can pull lightly on the pinna orpress on the small knobby structure that guards the ear canal. If the pain increases by this, weknow that the cause of the pain is in the outer ear.What to do if outer ear is infected? Carefully clean the pus out of the ear canal with some cotton wrapped on a match stick or a clean broom twig. Mix one spoon of vinegar with one spoon of boiled water, and put a few drops of this into the ear 3 to 4 times a day. If there is fever as well, give COTRIMOXAZOLE or AMOXYCILLIN by mouth for five days. For relief from pain PARACETAMOL or ASPIRIN may be given.
2-232. Infection of the middle earThe middle ear usually gets infected by bacteria. This kind of infection is common in children.Fever, pus coming out of the ear and repeating crying of a child who rubs the side of his headcan tell us about infection of the middle ear. At times there is pain in the ear as well. The earinfection keeps coming again and again unless treated well the first time itself.What to do if middle ear is infected? Give COTRIMOXAZOLE or AMOXYCILLIN by mouth for seven to ten days. PARACETAMOL or ASPIRIN for relief from pain may be given. Carefully clean the pus out of the ear canal with some cotton wrapped on a matchstick or a clean broom twig. DO NOT allow such children to swim. They may have a bath, but be careful that no water gets in their ears. You can plug their ears with a twisted piece of paper wrapped in a plastic. To avoid getting infections of the middle ear , Teach children to wipe and NOT TO BLOW their noses during a cold. Keep the child on a nutritious diet always. DO NOT FEED a child with a bottle while she is lying on her Teach children not to blow their nose when back as it may flow back through her ear tube from her throat they have a cold into her middle ear. 3. Inner Ear Infections Half-circle canals in the inner ears help us keep our body balance. If there are repeated middle ear infections, the infection may travel to the inner ear and may also destroy the semi-circular canals. This may cause problems in understanding the posture and lead to a sense of imbalance. EARWAX Squirt warm water with Earwax is normal. To keep the ear clean, gently clean with syringe (without needle) to cotton or the rolled end of a cloth. clean inside of ears If it is too much and one gets itching, loss of hearing or a ringing sound in the ear, one can put 3 to five drops of clean oil daily for three days to soak it and then ask someone trained to remove the wax. Or use a syringe (without nee- dle) with warm water and squirt inside the ear to clean it. These days one gets wax dissolving solutions also in the chemist’s shop, but usually these are not necessary.
2-24 DEAFNESSDeafness Is Caused By : Either middle ear infections, earwax or due to a problem with the nerves going from the ear to the brain. Some drugs like Aspirin and Streptomycin (for TB) in large doses may also cause deafness. Children may be born deaf if their mother suffered from some illness in pregnancy or if she took TB drugs.If the causes as described earlier in this session cannot be found,take the child to an ENT (Ear, Nose and Throat) specialist. If a causeis found, try to treat it at the earliest. Using Hearing Aids Hearing aids or machines help to Note: If a government ENT increase the energy of the sound that specialist or District Civil Sur- goes till the inner ear. In people who are geon certifies that a person is partially deaf, they can help in hearing hard of hearing, a person can better. get an electrical hearing aid free of cost from the government If the eardrum has got punctured either through the district social wel- by infection or accidentally while fare department. ‘cleaning’ the ear, nowadays there are operations these days to help repair the eardrum. THROAT Problems What to do when you have a Sore Throat? • For a sore throat, gargling with warm salt water every few hours is considered very good. • When your throat feels sore, take plenty of hot fluids. Drinking cups of hot ginger tea can do wonders to a sore throat. • If the voice has cracked, breathe some hot vapour as discussed Gargle with warm earlier – the more times a day we can take, the better for us!. water • A type of bacteria – that causes sore throat can also harm the heart valves and trouble the joints. Therefore, children below the age of fifteen should be given germ- killing medicines or antibiotics as soon as they get a sore throat. If they get sore throat again and again or they have already got the heart disease, it makes better sense to give them a monthly injection of Penicillin!
2-25 Know the Answers Diseases of the Breathing System1. Say whether this is right or wrong: a. Common cold can be cured with antibiotics. b. Vapour inhalation is the cheapest and best way that helps the lungs in fighting infection. c. Sputum should be examined for T.B. d. X-Rays are the best method to diagnose T.B. e. Pneumonia for children always need injection for treatment. f. Sore Throat in children must always be trateded with antibiotics. g. Cough syrups help to stop cough.2. The main indicators of T.B are: a. b. c.3. Dray cough may be caused by: a. b. c. d.4. Pneumonia of children can be treated with the following: a. b. c. d.