Sputum Health Dictionary

In?ammation of the bronchial tubes (see AIR PASSAGES; BRONCHUS; LUNGS). This may occur as an acute transient illness or as a chronic condition.

Acute bronchitis is due to an acute infection – viral or bacterial – of the bronchi. This is distinguished from PNEUMONIA by the anatomical site involved: bronchitis affects the bronchi whilst pneumonia affects the lung tissue. The infection causes a productive cough, and fever. Secretions within airways sometimes lead to wheezing. Sometimes the speci?c causative organism may be identi?ed from the sputum. The illness is normally self-limiting but, if treatments are required, bacterial infections respond to a course of antibiotics.

Chronic bronchitis is a clinical diagnosis applied to patients with chronic cough and sputum production. For epidemiological studies it is de?ned as ‘cough productive of sputum on most days during at least three consecutive months for not less than two consecutive years’. Chronic bronchitis is classi?ed as a CHRONIC PULMONARY OBSTRUCTIVE DISEASE (COPD); chronic ASTHMA and EMPHYSEMA are the others.

In the past, industrial workers regularly exposed to heavily polluted air commonly developed bronchitis. The main aetiological factor is smoking; this leads to an increase in size and number of bronchial mucous glands. These are responsible for the excessive mucus production within the bronchial tree, causing a persistent productive cough. The increased number of mucous glands along with the in?ux of in?ammatory cells may lead to airway-narrowing: when airway-narrowing occurs, it slows the passage of air, producing breathlessness. Other less important causative factors include exposure to pollutants and dusts. Infections do not cause the disease but frequently produce exacerbations with worsening of symptoms.

Treatments involve the use of antibiotics to treat the infections that produce exacerbations of symptoms. Bronchodilators (drugs that open up the airways) help to reverse the airway-narrowing that causes the breathlessness. PHYSIOTHERAPY is of value in keeping the airways clear of MUCUS. Cessation of smoking reduces the speed of progression.... bronchitis

Damage to bronchi when ballooned beyond normal limits, usually from chronic infection. May be a legacy from lung infections, whooping cough, measles, tuberculosis, foreign body or other bronchial troubles. Predisposing factors: smoking, working with asbestos and other industrial materials. Now known that some structural changes in bronchial epithelium caused by cigarette smoking are reversible by abstinence for over two years.

A plug of tenacious mucus may be clogged in the bronchial tree and gradually sucked into the smaller bronchi, blocking them. This prevents air from passing through to replace air that has been absorbed and precipitates cough, sputum, spitting of blood. A stethoscope reveals crepitations; chronic cases may be detected by clubbing of the fingers, which sign may be missing in bronchitis and other chest infections. Alternatives. Treatment. Bronchitics are most at risk and should never neglect a cold. Stimulating expectorants followed by postural drainage indicated. To control infection, plenty of Echinacea should be given. Where a localised area becomes septic a surgical lobectomy may be necessary. See: POSTURAL DRAINAGE. Cases of developed bronchiectasis can be maintained relatively well over a period of years by judicious use of herbs: Bayberry bark, Blood root, Elecampane root, Ephedra, Eucalyptus oil, Grindelia, Senega root, Mullein, Pleurisy root, Red Clover. Lobelia. Not Comfrey.

Tea. Formula. Equal parts: Yarrow, Mullein, Lungwort. 1 heaped teaspoon in each cup boiling water; infuse 5-15 minutes; 1 cup morning and evening and when necessary.

Powders. Mix: Lobelia 2; Grindelia quarter; Capsicum quarter. Dose: 500mg (two 00 capsules or one- third teaspoon) morning, evening and when necessary.

Tablets/capsules. Iceland Moss. Lobelia.

Tinctures. Formula. Ephedra 2; Echinacea 1; Elecampane root 1; Capsicum quarter. dose: 2-5ml teaspoons morning and evening and when necessary.

Practitioner. Liquid Extract Senega 1; Ephedra 1; Lungwort 2 (spitting of blood add: Blood root quarter). Dose: 2-5ml morning and evening and when necessary. In advanced cases there may be swollen ankles and kidney breakdown for which Parsley root, Buchu or Juniper may be indicated.

The sucking of a clove (or single drop of oil of Cloves in honey) has given temporary relief. Aromatherapy. Inhalants or chest-rub – Eucalyptus, Cajeput, Hyssop, Rosemary, Sandalwood.

Diet. Wholefoods. Low fat, low salt, high fibre. Avoid all dairy foods.

Supplementation. Vitamin B-complex. Vitamin E for increased oxygenation. Vitamins A, C, D, F. Outlook. Relief possible from regular herbal regime as dispensed by qualified practitioner. Requirements of each individual case may differ. ... bronchiectasis

A natural re?ex reaction to irritation of the AIR PASSAGES and LUNGS. Air is drawn into the air passages with the GLOTTIS wide open. The inhaled air is blown out against the closed glottis, which, as the pressure builds up, suddenly opens, expelling the air – at an estimated speed of 960 kilometres (600 miles) an hour. This explosive exhalation expels harmful substances from the respiratory tract. Causes of coughing include infection – for example, BRONCHITIS or PNEUMONIA; in?ammation of the respiratory tract associated with ASTHMA; and exposure to irritant agents such as chemical fumes or smoke (see also CROUP).

The explosive nature of coughing results in a spray of droplets into the surrounding air and, if these are infective, hastens the spread of colds (see COLD, COMMON) and INFLUENZA. Coughing is, however, a useful reaction, helping the body to rid itself of excess phlegm (mucus) and other irritants. The physical e?ort of persistent coughing, however, can itself increase irritation of the air passages and cause distress to the patient. Severe and protracted coughing may, rarely, fracture a rib or cause PNEUMOTHORAX. Coughs can be classi?ed as productive – when phlegm is present – and dry, when little or no mucus is produced.

Most coughs are the result of common-cold infections but a persistent cough with yellow or green sputum is indicative of infection, usually bronchitis, and sufferers should seek medical advice as medication and postural drainage (see PHYSIOTHERAPY) may be needed. PLEURISY, pneumonia and lung CANCER are all likely to cause persistent coughing, sometimes associated with chest pain, so it is clearly important for people with a persistent cough, usually accompanied by malaise or PYREXIA, to seek medical advice.

Treatment Treatment of coughs requires treatment of the underlying cause. In the case of colds, symptomatic treatment with simple remedies such as inhalation of steam is usually as e?ective as any medicines, though ANALGESICS or ANTIPYRETICS may be helpful if pain or a raised temperature are among the symptoms. Many over-the-counter preparations are available and can help people cope with the symptoms. Preparations may contain an analgesic, antipyretic, decongestant or antihistamine in varying combinations. Cough medicines are generally regarded by doctors as ine?ective unless used in doses so large they are likely to cause sedation as they act on the part of the brain that controls the cough re?ex.

Cough suppressants may contain CODEINE, DEXTROMETHORPHAN, PHOLCODINE and sedating ANTIHISTAMINE DRUGS. Expectorant preparations usually contain subemetic doses of substances such as ammonium chloride, IPECACUANHA, and SQUILL (none of which have proven worth), while demulcent preparations contain soothing, harmless agents such as syrup or glycerol.

A list of systemic cough and decongestant preparations on sale to the public, together with their key ingredients, appears in the British National Formulary.... cough

See sputum.... phlegm

Pneumonia is an in?ammation of the lung tissue (see LUNGS) caused by infection. It can occur without underlying lung or general disease, or in patients with an underlying condition that makes them susceptible.

Pneumonia with no predisposing cause – community-acquired pneumonia – is caused most often by Streptococcus pneumoniae (PNEUMOCOCCUS). The other most common causes are viruses, Mycoplasma pneumoniae and Legionella species (Legionnaire’s disease). Another cause, Chlamydia psittaci, may be associated with exposure to perching birds.

In patients with underlying lung disease, such as CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) or BRONCHIECTASIS as in CYSTIC FIBROSIS, other organisms such as Haemophilus in?uenzae, Klebsiella, Escherichia coli and Pseudomonas aeruginosa are more prominent. In patients in hospital with severe underlying disease, pneumonia, often caused by gram-negative bacteria (see GRAM’S STAIN), is commonly the terminal event.

In patients with an immune system suppressed by pregnancy and labour, infection with HIV, CHEMOTHERAPY or immunosuppressive drugs after organ transplantation, a wider range of opportunistic organisms needs to be considered. Some of these organisms such as CYTOMEGALOVIRUS (CMV) or the fungus Pneumocystis carinii rarely cause disease in immunocompetent individuals – those whose body’s immune (defence) system is e?ective.

TUBERCULOSIS is another cause of pneumonia, although the pattern of lung involvement and the more chronic course usually di?erentiate it from other causes of pneumonia.

Symptoms The common symptoms of pneumonia are cough, fever (sometimes with RIGOR), pleuritic chest pain (see PLEURISY) and shortness of breath. SPUTUM may not be present at ?rst but later may be purulent or reddish (rusty).

Examination of the chest may show the typical signs of consolidation of an area of lung. The solid lung in which the alveoli are ?lled with in?ammatory exudate is dull to percussion but transmits sounds better than air-containing lung, giving rise to the signs of bronchial breathing and increased conduction of voice sounds to the stethoscope or palpating hand.

The chest X-ray in pneumonia shows opacities corresponding to the consolidated lung. This may have a lobar distribution ?tting with limitation to one area of the lung, or have a less con?uent scattered distribution in bronchopneumonia. Blood tests usually show a raised white cell (LEUCOCYTES) count. The organism responsible for the pneumonia can often be identi?ed from culture of the sputum or the blood, or from blood tests for the speci?c ANTIBODIES produced in response to the infection.

Treatment The treatment of pneumonia involves appropriate antibiotics together with oxygen, pain relief and management of any complications that may arise. When treatment is started, the causative organism has often not been identi?ed so that the antibiotic choice is made on the basis of the clinical features, prevalent organisms and their sensitivities. In severe cases of community-acquired pneumonia (see above), this will often be a PENICILLIN or one of the CEPHALOSPORINS to cover Strep. pneumoniae together with a macrolide such as ERYTHROMYCIN. Pleuritic pain will need analgesia to allow deep breathing and coughing; oxygen may be needed as judged by the oxygen saturation or blood gas measurement.

Possible complications of pneumonia are local changes such as lung abscess, pleural e?usion or EMPYEMA and general problems such as cardiovascular collapse and abnormalities of kidney or liver function. Appropriate treatment should result in complete resolution of the lung changes but some FIBROSIS in the lung may remain. Pneumonia can be a severe illness in previously ?t people and it may take some months to return to full ?tness.... pneumonia

A genetic condition in children in which a defective gene is responsible for altered body chemistry, with excess secretion from the mucous glands. Thick mucus in the lungs may cause breathing distress; in the liver it may block ducts and inhibit function. Liver, pancreatic and salivary glands may be involved. Selenium and Vitamin E levels low (supplementation advised).

Symptoms. Respiratory difficulties and irritating cough. Thick sputum changes colour with infection. Sweat is high in salt. Evil-smelling stool. Treatment by or in liaison with general medical practitioner only.

Until recent years the condition was fatal by death from pneumonia. Carriers may be symptomless. Survival is largely in the hands of physiotherapists and osteopaths who give postural drainage. Differential diagnosis. Infant’s asthma, bronchitis, coeliac disease.

Having regards to missing enzymes (digestive and others) a hard look at food proves rewarding. Individuals may lack the necessary enzymes to break down wheat; one reason why wheat products should be avoided. Production of mucous is reduced considerably by the gluten diet in which oats, wheat, rye and barley are avoided. See: GLUTEN-SENSITIVE DISEASE.

To avoid infection, herbal antibiotics: Wild Yam, Echinacea, Wild Indigo, Goldenseal, Myrrh. Alternatives. To stimulate production of pancreatic enzymes, and peristalsis. Daily physiotherapy to prevent retention of viscid secretions.

Supportive treatment. To liquefy mucus.

Teas: Hyssop, White Horehound, Gotu Kola. Fenugreek seed. Alfalfa.

Tablets/capsules. Lobelia. Iceland Moss. Goldenseal. Echinacea. Wild Yam.

Powders. Formula: equal parts: Elecampane, White Horehound, Dandelion; pinch Cayenne. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.

Tinctures. Formula: equal parts: Elecampane, Lobelia, Dandelion. Few drops Tincture Capsicum. One to two 5ml teaspoons in water 3-4 times daily.

Friar’s Balsam. Inhalation helps to thin mucus from the bronchi.

Supplementation. In addition to Selenium and Vitamin E: Vitamins A, B-complex, C, D. Pancreatic enzymes. High calorie intake. ... cystic fibrosis

The nursing of a patient suffering from an infectious disease in such a way that the risk of their passing on the disease to others is reduced. Thus, precautions are taken to ensure that all infective matter – such as stools, urine, sputum, discharge from wounds, and anything that may be contaminated by such infective matter (e.g. nurses’ uniforms, bedding and towels) – is so treated that it will not convey the infection. (See NURSING.)... barrier nursing

Basil tea is an Ayurvedic natural remedy used to treat a wide variety of diseases such as asthma, diabetes and high cholesterol. Hindus worship the plant for its religious significance as well. Basil Tea description Basil, a plant from the mint family, is original from India and Asia. It is an aromatic herb with a strong fragrance being largely used in spaghetti sauces, stews and tomato recipes. Basil is a source of vitamins and other nutrients.  Studies showed that this herb has anti-bacterial and anti-inflammatory health properties, fighting against intestinal problems, headaches and ulcers, as well. In aromatherapy, basil is used to alleviate mental fatigue. Basil tea is the resulting beverage from brewing the abovementioned plant. Basil Tea brewing To prepare Basil tea:

• bring the water and the basil leaves to boil (in a small tea pan)
• lower the heat and allow it to brew for 3-4 minutes
• add the tea leaves or tea bags and sugar according to taste
• bring to boil
• turn off the heat
• strain it into cups and add milk according to taste

Basil Tea benefits Studies claimed that Basil Tea is successesfully used to:

• treat intestinal colics, gastric ulcers and bloating/swelling of the abdomen
• treat anorexia
• fight urinary tract infections
• help against diarrhea
• help fight insomnia
• help treat lesions and inflammations in the mouth
• enhance the body’s ability to resist stress
• help to relieve pain

Basil Tea side effects Basil tea side effects are generally associated to large intakes. There have been thus noticed:shallow breathing, blood in the urine or sputum, mouth and throat burns, nausea, racing heartbeat, seizures, dizziness and coma. Pregnant or breastfeeding women, as well as women trying to become pregnant should not use Basil tea. Basil tea has anti-inflammatory and anti-microbial properties, proving itself to be an important adjuvant in treating arthritis, fevers and other ailments. It is also constantly used to add savor to several dishes.... basil tea has anti-inflammatory properties

A term applied to signs or symptoms which are especially characteristic of certain diseases, and on the presence or absence of which the diagnosis depends. Thus the discovery of the Mycobacterium tuberculosis in the sputum is said to be pathognomonic of pulmonary tuberculosis.... pathognomonic

In?ammation of the TRACHEA. It may occur along with BRONCHITIS, or independently, due to similar causes. Usually a viral condition, treatment may be unnecessary (see CROUP). A rare condition, bacterial tracheitis, is more dangerous as the patient produces large amount of thick, sticky SPUTUM which may block the airway causing respiratory failure and collapse. Treatment is by insertion of an endotracheal tube under general anaesthesia (see ENDOTRACHEAL INTUBATION), removing the secretions and using high-dose antibiotics.... tracheitis

The coughing up of blood, or sputum mixed with blood from the lungs. See: BLEEDING, FROM THE LUNGS. ... haemoptysis

A drug used in the treatment of paracetamol overdose and as a mucolytic drug to loosen sputum.

When the drug is taken in large doses, vomiting or rash may occur as rare side effects.... acetylcysteine

Over-the-counter medications for treating a cough. There are various preparations, but the effectiveness of most is unproven. Expectorant cough remedies are purported to encourage expulsion of sputum. Cough suppressants, which control the coughing reflex, include some antihistamine drugs and codeine. All cough suppressants may cause drowsiness.... cough remedies

This is a term encompassing chronic BRONCHITIS, EMPHYSEMA, and chronic ASTHMA where the air?ow into the lungs is obstructed.

Chronic bronchitis is typi?ed by chronic productive cough for at least three months in two successive years (provided other causes such as TUBERCULOSIS, lung cancer and chronic heart failure have been excluded). The characteristics of emphysema are abnormal and permanent enlargement of the airspaces (alveoli) at the furthermost parts of the lung tissue. Rupture of alveoli occurs, resulting in the creation of air spaces with a gradual breakdown in the lung’s ability to oxygenate the blood and remove carbon dioxide from it (see LUNGS). Asthma results in in?ammation of the airways with the lining of the BRONCHIOLES becoming hypersensitive, causing them to constrict. The obstruction may spontaneously improve or do so in response to bronchodilator drugs. If an asthmatic patient’s airway-obstruction is characterised by incomplete reversibility, he or she is deemed to have a form of COPD called asthmatic bronchitis; sufferers from this disorder cannot always be readily distinguished from those people who have chronic bronchitis and/ or emphysema. Symptoms and signs of emphysema, chronic bronchitis and asthmatic bronchitis overlap, making it di?cult sometimes to make a precise diagnosis. Patients with completely reversible air?ow obstruction without the features of chronic bronchitis or emphysema, however, are considered to be suffering from asthma but not from COPD.

The incidence of COPD has been increasing, as has the death rate. In the UK around 30,000 people with COPD die annually and the disorder makes up 10 per cent of all admissions to hospital medical wards, making it a serious cause of illness and disability. The prevalence, incidence and mortality rates increase with age, and more men than women have the disorder, which is also more common in those who are socially disadvantaged.

Causes The most important cause of COPD is cigarette smoking, though only 15 per cent of smokers are likely to develop clinically signi?cant symptoms of the disorder. Smoking is believed to cause persistent airway in?ammation and upset the normal metabolic activity in the lung. Exposure to chemical impurities and dust in the atmosphere may also cause COPD.

Signs and symptoms Most patients develop in?ammation of the airways, excessive growth of mucus-secreting glands in the airways, and changes to other cells in the airways. The result is that mucus is transported less e?ectively along the airways to eventual evacuation as sputum. Small airways become obstructed and the alveoli lose their elasticity. COPD usually starts with repeated attacks of productive cough, commonly following winter colds; these attacks progressively worsen and eventually the patient develops a permanent cough. Recurrent respiratory infections, breathlessness on exertion, wheezing and tightness of the chest follow. Bloodstained and/or infected sputum are also indicative of established disease. Among the symptoms and signs of patients with advanced obstruction of air?ow in the lungs are:

RHONCHI (abnormal musical sounds heard through a STETHOSCOPE when the patient breathes out).

marked indrawing of the muscles between the ribs and development of a barrel-shaped chest.

loss of weight.

CYANOSIS in which the skin develops a blue tinge because of reduced oxygenation of blood in the blood vessels in the skin.

bounding pulse with changes in heart rhythm.

OEDEMA of the legs and arms.

decreasing mobility.

Some patients with COPD have increased ventilation of the alveoli in their lungs, but the levels of oxygen and carbon dioxide are normal so their skin colour is normal. They are, however, breathless so are dubbed ‘pink pu?ers’. Other patients have reduced alveolar ventilation which lowers their oxygen levels causing cyanosis; they also develop COR PULMONALE, a form of heart failure, and become oedematous, so are called ‘blue bloaters’.

Investigations include various tests of lung function, including the patient’s response to bronchodilator drugs. Exercise tests may help, but radiological assessment is not usually of great diagnostic value in the early stages of the disorder.

Treatment depends on how far COPD has progressed. Smoking must be stopped – also an essential preventive step in healthy individuals. Early stages are treated with bronchodilator drugs to relieve breathing symptoms. The next stage is to introduce steroids (given by inhalation). If symptoms worsen, physiotherapy – breathing exercises and postural drainage – is valuable and annual vaccination against INFLUENZA is strongly advised. If the patient develops breathlessness on mild exertion, has cyanosis, wheezing and permanent cough and tends to HYPERVENTILATION, then oxygen therapy should be considered. Antibiotic treatment is necessary if overt infection of the lungs develops.

Complications Sometimes rupture of the pulmonary bullae (thin-walled airspaces produced by the breakdown of the walls of the alveoli) may cause PNEUMOTHORAX and also exert pressure on functioning lung tissue. Respiratory failure and failure of the right side of the heart (which controls blood supply to the lungs), known as cor pulmonale, are late complications in patients whose primary problem is emphysema.

Prognosis This is related to age and to the extent of the patient’s response to bronchodilator drugs. Patients with COPD who develop raised pressure in the heart/lung circulation and subsequent heart failure (cor pulmonale) have a bad prognosis.... chronic obstructive pulmonary disease (copd)

A recurrent cough in smokers.

The cough is usually triggered by the accumulation of thick sputum in the airways due to inflammation caused by smoking.

Giving up smoking usually stops the cough but it may take time.

In general, the longer a person has been smoking, the longer it will take.

Smokers with a cough should seek medical advice, particularly if their cough changes, because smoking is associated with lung cancer (see tobacco-smoking).... cough, smoker’s

Cough remedies that encourage the coughing up of sputum.... expectorants

The coughing up and spitting out of sputum.... expectoration

A form of pneumonia that is caused by LEGIONELLA PNEUMOPHILA, a bacterium that breeds in warm, moist conditions. The source of infection is often an air-conditioning system in a large, public building.

The first symptoms include headache, muscular and abdominal pain, diarrhoea, and a dry cough.

Over the next few days, pneumonia develops, resulting in a high fever, shaking chills, coughing up of thick sputum (phlegm), drowsiness, and sometimes delirium.

Treatment is with the antibiotic drug erythromycin.... legionnaires’ disease

This occurs as a result of left ventricular failure (see HEART, DISEASES OF). There is an abrupt increase in the venous and capillary pressure in the pulmonary vessels, followed by ?ooding of ?uid into the interstitial spaces and alveoli. The commonest cause of acute pulmonary oedema is myocardial infarction (see HEART, DISEASES OF) which reduces the ability of the left ventricular myocardial muscle to handle the blood delivered to it. Pulmonary oedema may result from other causes of left ventricular failure such as HYPERTENSION or valvular disease of the mitral and aortic valves. The initial symptoms are cough with breathlessness and occasionally with wheezing (once called ‘cardiac asthma’). The patient becomes extremely short of breath and in a severe attack the patient is pale, sweating and cyanosed and obviously gasping for breath. Frequently, frothy sputum is produced which may be blood-stained. Treatment is with DIURETICS and measures to deal with the myocardial infarction or other underlying cause.... oedema of the lungs

Drugs that make sputum (phlegm) less sticky and easier to cough up. An example is acetylcysteine.... mucolytic drugs

In?uenza is an acute infectious disease, characterised by a sudden onset, fever and generalised aches and pains. It usually occurs in epidemics and pandemics (see EPIDEMIC; PANDEMIC).

Cause The disease is caused by a VIRUS of the in?uenza group. There are at least three types of in?uenza virus, known respectively as A, B and

C. One of their most characteristic features is that infection with one type provides no protection against another. Equally important is the ease with which the in?uenza virus can change its character. It is these two characteristics which explain why one attack of in?uenza provides little, if any, protection against a subsequent attack, and why it is so di?cult to prepare an e?ective vaccine against the disease.

Epidemics of in?uenza due to virus A occur in Britain at two- to four-year intervals, and outbreaks of virus B in?uenza in less frequent cycles. Virus A in?uenza, for instance, was the prevalent infection in 1949, 1951, 1955 and 1956, whilst virus B in?uenza was epidemic in 1946, 1950, 1954 and, along with virus A, in 1958–59. The pandemic of 1957, which swept most of the world, although fortunately not in a severe form, was due to a new variant of virus A

– the so-called Asian virus – and it has been suggested that it was this variant that was responsible for the pandemics of 1889 and 1918. Since 1957, variants of virus A have been the predominating causes of in?uenza, accompanied on occasions by virus B.

In 1997 and 2004, outbreaks of Chinese avian in?uenza caused alarm. The in?uenza virus had apparently jumped species from birds

– probably chickens – to infect some people. Because no vaccine is available, there was a risk that this might start an epidemic.

Symptoms The incubation period of in?uenza A and B is 2–3 three days, and the disease is characterised by a sudden onset. In most cases this is followed by a short, sharp febrile illness of 2–4 days’ duration, associated with headache, prostration, generalised aching, and respiratory symptoms. In many cases the respiratory symptoms are restricted to the upper respiratory tract, and consist of signs of irritation of the nose, pharynx and larynx. There may be nosebleeds, and a dry, hacking cough is often a prominent and troublesome symptom. The fever is usually remittent and the temperature seldom exceeds 39·4 °C (103 °F), tending to ?uctuate between 38·3 and 39·4 °C (101 and 103 °F).

The most serious complication is infection of the lungs. This infection is usually due to organisms other than the in?uenza virus, and is a complication which can have serious results in elderly people.

The very severe form of ’?u which tends to occur during pandemics – and which was so common during the 1918–19 pandemic – is characterised by the rapid onset of bronchopneumonia and severe prostration. Because of the toxic e?ect on the heart, there is a particularly marked form of CYANOSIS, known as heliotrope cyanosis.

Convalescence following in?uenza tends to be prolonged. Even after an attack of average severity there tends to be a period of weakness and depression.

Treatment Expert opinion is still divided as to the real value of in?uenza vaccine in preventing the disease. Part of the trouble is that there is little value in giving any vaccine until it is known which particular virus is causing the infection. As this varies from winter to winter, and as the protection given by vaccine does not exceed one year, it is obviously not worthwhile attempting to vaccinate the whole community. The general rule therefore is that, unless there is any evidence that a particularly virulent type of virus is responsible, only the most vulnerable should be immunised – such as children in boarding schools, elderly people, and people who suffer from chronic bronchitis or asthma, chronic heart disease, renal failure, diabetes mellitus or immunosuppression (see under separate entries). In the face of an epidemic, people in key positions, such as doctors, nurses and those concerned with public safety, transport and other public utilities, should be vaccinated.

For an uncomplicated attack of in?uenza, treatment is symptomatic: that is, rest in bed, ANALGESICS to relieve the pain, sedatives, and a light diet. A linctus is useful to sooth a troublesome cough. The best analgesics are ASPIRIN or PARACETAMOL. None of the sulphonamides or the known antibiotics has any e?ect on the in?uenza virus; on the other hand, should the lungs become infected, antibiotics should be given immediately, because such an infection is usually due to other organisms. If possible, a sample of sputum should be examined to determine which organisms are responsible for the lung infection. The choice of antibiotic then depends upon which antibiotic the organism is most sensitive to.... influenza

An infection of the lungs caused by PNEUMOCYSTIS CARINII, a type of protozoa. Pneumocystis pneumonia is an opportunistic infection that is dangerous only to people with impaired resistance to infection. It is particularly common in those with AIDS. Symptoms include fever, dry cough, and shortness of breath lasting weeks to months. Diagnosis is made by examination of sputum or a lung biopsy. High doses of antibiotic drugs (commonly cotrimoxazole) may eradicate the infection; they may also be used over the long term to prevent infection in those people at increased risk.... pneumocystis pneumonia

A technique that enables sputum (phlegm) or other secretions to drain from a person’s lungs in order to clear them.

The person lies in a way that allows the secretions to drain by gravity into the trachea, from where they are coughed up.

Tapping the person’s chest with cupped hands can help to loosen sticky secretions.... postural drainage

Accumulation of fluid in the lungs, usually due to leftsided heart failure. It may also be due to chest infection, inhalation of irritant gases, or to any of the causes of generalized oedema. The main symptom is breathlessness, which is usually worse when lying flat and may disturb sleep. There may be a cough, producing frothy, sometimes pink, sputum. Breathing may sound bubbly or wheezy.

A diagnosis is made by a physical examination and by a chest X-ray. Treatment may include morphine, diuretic drugs, aminophylline, and oxygen therapy; artificial ventilation may also be given.... pulmonary oedema

fine colourless sharp-pointed crystals seen in the sputum of asthmatics. [J. M. Charcot (1825–93), French neurologist; E. V. von Leyden (1832–1910), German physician]... charcot–leyden crystals

been recognised from earliest times. Evidence of the condition has been found in Egyptian mummies; in the fourth century BC Hippocrates, the Greek physician, called it phthisis because of the lung involvement; and in 1882 Koch announced the discovery of the causative organism, the tubercle bacillus or Mycobacterium tuberculosis.

The symptoms depend upon the site of the infection. General symptoms such as fever, weight loss and night sweats are common. In the most common form of pulmonary tuberculosis, cough and blood-stained sputum (haemoptysis) are common symptoms.

The route of infection is most often by inhalation, although it can be by ingestion of products such as infected milk. The results of contact depend upon the extent of the exposure and the susceptibility of the individual. Around 30 per cent of those closely exposed to the organism will be infected, but most will contain the infection with no signi?cant clinical illness and only a minority will go on to develop clinical disease. Around 5 per cent of those infected will develop post-primary disease over the next two or three years. The rest are at risk of reactivation of the disease later, particularly if their resistance is reduced by associated disease, poor nutrition or immunosuppression. In developed countries around 5 per cent of those infected will reactivate their healed tuberculosis into a clinical problem.

Immunosuppressed patients such as those infected with HIV are at much greater risk of developing clinical tuberculosis on primary contact or from reactivation. This is a particular problem in many developing countries, where there is a high incidence of both HIV and tuberculosis.

Diagnosis This depends upon identi?cation of mycobacteria on direct staining of sputum or other secretions or tissue, and upon culture of the organism. Culture takes 4–6 weeks but is necessary for di?erentiation from other non-tuberculous mycobacteria and for drug-sensitivity testing. Newer techniques involving DNA ampli?cation by polymerase chain reaction (PCR) can detect small numbers of organisms and help with earlier diagnosis.

Treatment This can be preventative or curative. Important elements of prevention are adequate nutrition and social conditions, BCG vaccination (see IMMUNISATION), an adequate public-health programme for contact tracing, and chemoprophylaxis. Radiological screening with mass miniature radiography is no longer used.

Vaccination with an attenuated organism (BCG – Bacillus Calmette Guerin) is used in the United Kingdom and some other countries at 12–13 years, or earlier in high-risk groups. Some studies show 80 per cent protection against tuberculosis for ten years after vaccination.

Cases of open tuberculosis need to be identi?ed; their close contacts should be reviewed for evidence of disease. Adequate antibiotic chemotherapy removes the infective risk after around two weeks of treatment. Chemoprophylaxis – the use of antituberculous therapy in those without clinical disease – may be used in contacts who develop a strong reaction on tuberculin skin testing or those at high risk because of associated disease.

The major principles of antibiotic chemotherapy for tuberculosis are that a combination of drugs needs to be used, and that treatment needs to be continued for a prolonged period – usually six months. Use of single agents or interrupted courses leads to the development of drug resistance. Serious outbreaks of multiply resistant Mycobacterium tuberculosis have been seen mainly in AIDS units, where patients have greater susceptibility to the disease, but also in developing countries where maintenance of appropriate antibacterial therapy for six months or more can be di?cult.

Streptomycin was the ?rst useful agent identi?ed in 1944. The four drugs used most often now are RIFAMPICIN, ISONIAZID, PYRAZINAMIDE and ETHAMBUTOL. Three to four agents are used for the ?rst two months; then, when sensitivities are known and clinical response observed, two drugs, most often rifampicin and isoniazid, are continued for the rest of the course. Treatment is taken daily, although thrice-weekly, directly observed therapy is used when there is doubt about the patient’s compliance. All the antituberculous agents have a range of adverse effects that need to be monitored during treatment. Provided that the treatment is prescribed and taken appropriately, response to treatment is very good with cure of disease and very low relapse rates.... nature of the disease tuberculosis has

The ‘English Disease’. The result of repeated attacks of the acute condition. Menace to the elderly when bronchi becomes thickened and narrowed. Inelastic walls secrete a thick purulent mucus of fetid odour which plugs tubes and arrests oxygen intake. Aggravated by cold and damp, hence the need of a warm house with warm bedroom. Causes are many: smoking, industrial pollution irritants, soot, fog, etc. Breathlessness and audible breathing sounds may present an alarming spectacle.

A steady herbal regime is required including agents which may coax sluggish liver or kidneys into action (Dandelion, Barberry). Sheer physical exhaustion may require Ginseng. For purulent sputum – Boneset, Elecampane, Pleurisy root. To increase resistance – Echinacea. Where due to tuberculosis – Iceland Moss. For blood-streaked mucus – Blood root. For fever – Elderflowers, Yarrow. To conserve cardiac energies – Hawthorn, Motherwort. A profuse sweat affords relief – Elderflowers.

Alternatives. Capsicum, Ephedra, Fenugreek, Garlic, Grindelia, Holy Thistle, Iceland Moss, Lobelia, Mullein, Pleurisy Root, Wild Cherry.

Tea. Formula. Iceland Moss 2; Mullein 1; Wild Cherry bark 1. 1 heaped teaspoon to each cup water gently simmered 10 minutes. Dose: 1 cup 2-3 times daily.

Powders. Pleurisy root 2; Echinacea 1; Holy Thistle 1. Pinch Ginger. Mix. Dose: 500mg (two 00 capsules or one-third teaspoon) 2-3 times daily.

Tinctures. Formula. Iceland Moss 2; Lobelia 2; Grindelia quarter; Capsicum quarter. Dose: 1-2 teaspoons two or more times daily.

Practitioner. Liquid Extract Ephedra BHP (1983), dose 1-3ml. Or: Tincture Ephedra BHP (1983), dose 6-8ml.

Topical. Same as for acute bronchitis.

Note: In a test at Trafford General Hospital, Manchester, blowing-up balloons proved of benefit to those with chronic bronchitis. Fourteen patients were asked to inflate balloons and 14 refrained from doing so. After 8 weeks, the balloon-blowers showed considerable improvement in walking and a sense of well- being. Breathlessness was reduced. Condition of the others was either unchanged or worse. ... bronchitis, chronic

n. a drug that enhances the expulsion of sputum from the air passages. *Mucolytic expectorants act by decreasing the viscosity of the bronchial secretions so that they are easier to cough up. Drugs such as *ipecacuanha and ammonium chloride are claimed to be stimulant expectorants in small quantities: they irritate the lining of the stomach, which is said to provide a stimulus for the reflex production of sputum by the glands in the bronchial mucous membrane. At higher doses they produce vomiting.... expectorant

The most common form of cancer throughout the world. Five year survival: 10 per cent. Its association with cigarette smoking is now established beyond doubt. Other causes include such occupational poisons as asbestos, arsenic, chromium, diesel fumes, etc. The squamous cell carcinoma is the most common of the four types.

Diagnosis is confirmed by sputum test, chest X-ray, bronchoscopy or biopsy. Earliest symptoms are persistent cough, pain in the chest, hoarseness of voice and difficulty of breathing. Physical examination is likely to reveal sensitivity and swelling of lymph nodes under arms.

Symptoms. Tiredness, lack of energy, possible pains in bones and over liver area. Clubbing of finger-tips indicate congestion of the lungs. Swelling of arms, neck and face may be obvious. A haematologist may find calcium salts in the blood. The supportive action of alteratives, eliminatives and lymphatic agents often alleviate symptoms where the act of swallowing has not been impaired.

Broncho-dilators (Lobelia, Ephedra, etc) assist breathing. Mullein has some reputation for pain relief. To arrest bleeding from the lesion (Blood root).

According to Dr Madaus, Germany, Rupturewort is specific on lung tissue. To disperse sputum (Elecampane, Red Clover). In advanced cases there may be swollen ankles and kidney breakdown for which Parsley root, Parsley Piert or Buchu may be indicated. Cough (Sundew, Irish Moss). Soft cough with much sputum (Iceland Moss). To increase resistance (Echinacea).

Alternatives. Secondary to primary treatment. Of possible value.

Teas. Violet leaves, Mullein leaves, Yarrow leaves, Gotu Kola leaves, White Horehound leaves. Flavour with a little Liquorice if unpalatable.

Tablets/capsules. Lobelia, Iceland Moss, Echinacea, Poke root.

Formula. Equal parts: Violet, Red Clover, Garden Thyme, Yarrow, Liquorice. Dose: Powders: 750mg (three 00 capsules or half a teaspoon. Liquid Extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons. Thrice daily, and during the night if relief is sought.

Practitioner. Tinctures BHP (1983). Ephedra 4; Red Clover 4, Yellow Dock 2; Bugleweed 2; Blood root quarter; Liquorice quarter (liquid extract). Mix. Start low: 30-60 drops in water before meals and at bedtime increasing to maximum tolerance level.

Aromatherapy. Oils: Eucalyptus or Thyme on tissue to assist breathing. Inhale.

Diet. See: DIET – CANCER.

Treatment by a general medical practitioner or hospital specialist. ... cancer - bronchial carcinoma

the spread of an infectious agent from one person or group to another, usually through contact with contaminated material, such as sputum or faeces. Compare vertical transmission.... horizontal transmission

n. an agent that dissolves or breaks down mucus. Mucolytics such as carbocisteine and dornase alfa (see DNAse) break down mucus in sputum and thus facilitate its expectoration; they are used to treat chest conditions involving excessive or thickened mucus secretions.... mucolytic

The name applied generally to dead or attenuated living infectious material introduced into the body, with the object of increasing its power to resist or to get rid of a disease. (See also IMMUNITY.)

Healthy people are inoculated with vaccine as a protection against a particular disease; this produces ANTIBODIES which will confer immunity against a subsequent attack of the disease. (See IMMUNISATION for programme of immunisation during childhood.)

Vaccines may be divided into two classes: stock vaccines, prepared from micro-organisms known to cause a particular disease and kept in readiness for use against that disease; and autogenous vaccines, prepared from microorganisms which are already in the patient’s body and to which the disease is due. Vaccines intended to protect against the onset of disease are of the former variety.

Autogenous vaccines are prepared by cultivating bacteria found in SPUTUM, URINE and FAECES, and in areas of in?ammation such as BOILS (FURUNCULOSIS). This type of vaccine was introduced by Wright about 1903.

Anthrax vaccine was introduced in 1882 for the protection of sheep and cattle against this disease. A safe and e?ective vaccine for use in human beings has now been evolved. (See ANTHRAX.)

BCG vaccine is used to provide protection against TUBERCULOSIS. (See also separate entry on BCG VACCINE.)

Cholera vaccine was introduced in India about 1894. Two injections are given at an interval of at least a week; this gives a varying degree of immunity for six months. (See CHOLERA.)

Diphtheria vaccine is available in several forms. It is usually given along with tetanus and pertussis vaccine (see below) in what is known as TRIPLE VACCINE. This is given in three doses: the ?rst at the age of two months; the second at three months; and the third at four months, with a booster dose at the age of ?ve years. (See DIPHTHERIA.)

Hay fever vaccine is a vaccine prepared from the pollen of various grasses. It is used in gradually increasing doses for prevention of HAY FEVER in those susceptible to this condition.

In?uenza vaccine A vaccine is now available for protection against INFLUENZA due to the in?uenza viruses A and B. Its use in Britain is customarily based on advice from the health departments according to the type of in?uenza expected in a particular year.

Measles, mumps and rubella (MMR) vaccines are given in combination early in the second year of life. A booster dose may prove necessary, as there is some interference between this vaccine and the most recent form of pertussis vaccine (see below) o?ered to children. Uptake has declined a little because of media reports suggesting a link with AUTISM – for which no reliable medical evidence (and much to the contrary) has been found by investigating epidemiologists. (See also separate entry for each disease, and for MMR VACCINE.)

Pertussis (whooping-cough) vaccine is prepared from Bordetella pertussis, and is usually given along with diphtheria and tetanus in what is known as triple vaccine. (See also WHOOPING-COUGH.)

Plague vaccine was introduced by Ha?kine, and appears to give useful protection, but the duration of protection is relatively short: from two to 20 months. Two injections are given at an interval of four weeks. A reinforcing dose should be given annually to anyone exposed to PLAGUE.

Poliomyelitis vaccine gives a high degree of protection against the disease. This is given in the form of attenuated Sabin vaccine which is taken by mouth – a few drops on a lump of sugar. Reinforcing doses of polio vaccine are recommended on school entry, on leaving school, and on travel abroad to countries where POLIOMYELITIS is ENDEMIC.

Rabies vaccine was introduced by Pasteur in 1885 for administration, during the long incubation period, to people bitten by a mad dog, in order to prevent the disease from developing. (See RABIES.)

Rubella vaccine, usually given with mumps and measles vaccine in one dose – called MMR VACCINE, see also above – now provides protection against RUBELLA (German measles). It also provides immunity for adolescent girls who have not had the disease in childhood and so ensures that they will not acquire the disease during any subsequent pregnancy – thus reducing the number of congenitally abnormal children whose abnormality is the result of their being infected with rubella via their mothers before they were born.

Smallpox vaccine was the ?rst introduced. As a result of the World Health Organisation’s successful smallpox eradication campaign – it declared the disease eradicated in 1980 – there is now no medical justi?cation for smallpox vaccination. Recently, however, there has been increased interest in the subject because of the potential threat from bioterrorism. (See also VACCINATION.)

Tetanus vaccine is given in two forms: (1) In the so-called triple vaccine, combined with diphtheria and pertussis (whooping-cough) vaccine for the routine immunisation of children (see above). (2) By itself to adults who have not been immunised in childhood and who are particularly exposed to the risk of TETANUS, such as soldiers and agricultural workers.

Typhoid vaccine was introduced by Wright and Semple for the protection of troops in the South African War and in India. TAB vaccine, containing Salmonella typhi (the causative organism of typhoid fever – see ENTERIC FEVER) and Salmonella paratyphi A and B (the organisms of paratyphoid fever – see ENTERIC FEVER) has now been replaced by typhoid monovalent vaccine, containing only S. typhi. The change has been made because the monovalent vaccine is less likely to produce painful arms and general malaise, and there is no evidence that the TAB vaccine gave any protection against paratyphoid fever. Two doses are given at an interval of 4–6 weeks, and give protection for 1–3 years.... vaccine

n. a genus of large tropical parasitic *flukes that are particularly prevalent in the Far East. The adults of P. westermani live in the human lungs, where they cause destruction and bleeding of the tissues (see paragonimiasis). However, they may also be found in other organs of the body. Eggs are passed out in the sputum and the larvae undergo their development in two other hosts, a snail and a crab.... paragonimus

an acute infection of the lung caused by any one of a number of viruses, such as *respiratory syncytial virus, adenovirus, influenza and parainfluenza viruses, and enteroviruses. It is characterized by headache, fever, muscle pain, and a cough that produces a thick sputum. The pneumonia can often occur with or subsequent to a systemic viral infection. Treatment is by supportive care, but antibiotics are administered if a bacterial infection is superimposed.... viral pneumonia

n. an abnormal high-pitched (sibilant) or low-pitched sound heard – either by the unaided human ear or through the stethoscope – mainly during expiration. Wheezes occur as a result of narrowing of the airways, such as results from *bronchospasm or increased secretion and retention of sputum; they are commonly heard in patients with asthma or chronic bronchitis.... wheeze

See: WEAKNESS.

ASTHMA. Spasmodic contraction of the bronchi following exercise, emotional tension, infection, allergens, pollens, house dust, colds.

Symptoms. Obstruction of airways with wheezing, rales or whistling sounds with a sense of constriction. Often related to eczema – ‘eczema of the epithelium’. Infantile eczema treated with suppressive ointments may drive the condition ‘inwards’ and worsen asthma. “My son’s eczema has got better, but he now has asthma” is a common observation.

Causes: hypersensitivity to domestic animals, horses and pet birds. Common salt. Red or white wine allergy. An older generation of practitioners recognised a renal-bronchial asthma encouraged by faulty kidney function. With addition of a relaxing diuretic (Dandelion, Buchu or Parsley root) to a prescription, respiratory symptoms often abate.

Broncho-dilators such as Ephedra and Wild Thyme are widely used by the practitioner. To relieve spasm: Lobelia, Pleurisy root. White Horehound, Ammoniacum, Cramp bark, Garlic, Grindelia, Hyssop.

Anti-cough agents serve to remove sticky sputum: Coltsfoot, Garden Thyme, Slippery Elm bark, Maidenhair Fern, Linseed, Bayberry bark.

For the chronic asthmatic, bacterial invasion spells distress, when Echinacea or Balm of Gilead should be added. Where an irregular pulse reveals heart involvement, add: Hawthorn or Lily of the Valley.

Lobelia is of special value for the anxious patient with spasm of the bronchi. Should be tried before resorting to powerful spray mists which frequently produce gastro-intestinal disturbance.

Alternatives. Teas. Coltsfoot, Comfrey, Horehound (White), Mullein, Skullcap, Marshmallow, Thyme, Valerian, Wild Cherry bark, Elecampane, Plantain. Formula: equal parts herbs Coltsfoot, Mullein, Valerian. 1-2 teaspoons to each cup boiling water; infuse 10-15 minutes; dose, 1 cup twice daily and when necessary.

Antispasmodic Drops. See entry.

Practitioner. Ephedra, Lobelia, Gelsemium, Grindelia, Euphorbia (pill-bearing spurge), Skunk Cabbage, Senega, Pulsatilla, Lily of the Valley (cardiac asthma), Thyme. Formula. Equal parts, Tincture Lobelia simp; Tincture Belladonna; Tincture Ephedra. 5-10 drops thrice daily (maintenance), 10-20 drops for spasm.

Cockayne, Ernest, FNIMH. Hyssop tea for children throughout childhood to avoid respiratory disorders. Dr Finlay Ellingwood. Gelsemium 3.5ml; Lobelia 3.5ml. Distilled water to 120ml. One 5ml teaspoon in water every 3 hours.

Dr Alfred Vogel. Ephedra 20 per cent; Ipecac 15 per cent; Hawthorn berry 10 per cent; Blessed Thistle 5 per cent; Burnet Saxifrage 5 per cent; Garden Thyme 5 per cent; Grindelia 1 per cent. 10-15 drops in water thrice daily.

Dr Wm Thomson. 1 teaspoon Ephedra herb to cup boiling water; infuse 10-15 minutes. Half-1 cup 2-3 times daily.

Traditional. 2 teaspoons shredded Elecampane root in cup cold water; stand overnight. Next day, heat to boiling point when required. Strain. Sips, hot, with honey: 1 cup 2-3 times daily.

Potter’s Asthma & Bronchitis Compound 32. 40g medicinal teabags. Ingredients: Clove BPC 4.84 per cent; Elecampane root 17.24 per cent; Horehound 26.20 per cent; Hyssop 17.24 per cent; Irish Moss 17.24 per cent; Liquorice 17.24 per cent. Dose: 1-2 teaspoons when necessary.

Chinese Medicine. Decoction or extract from the Gingko tree widely used, as also is Ephedra, Garlic, Liquorice and Bailcalensis.

Tablets/capsules. Lobelia. Iceland Moss, (Gerard). Euphorbia (Blackmore).

Powders. Formula. Lobelia 2; Hyssop 1; Elderflowers 1; Grindelia quarter; Liquorice quarter: pinch Cayenne. Dose: 750mg (three 00 capsules or half a teaspoon) 2-3 times daily.

Aromatherapy. 6 drops Rosemary oil in 2 teaspoons Almond oil for massage upper chest to relieve congestion.

Inhalation. See: INHALATIONS, FRIAR’S BALSAM.

Nebulizer. A germicidal solution is made from 5 drops oil Eucalyptus in one cup boiling water. Use in nebulizer for droplet therapy.

Ioniser – use of.

Cider Vinegar. Sips of the vinegar in water for whoop.

Supportives. Yoga. Singing. Cures have been reported of patients on taking up singing. “During singing, up to 90 per cent of the vital capacity may be used without a conscious effort to increase tidal volume.” (Dr M. Judson, New England Journal of Medicine)

Diet. Low salt, low fat, high fibre, cod liver oil, carrots, watercress, Soya beans or flour, lecithin, sunflower seed oil, green vegetables, raw fruit, fresh fish. These foods are valuable sources of antioxidant vitamins and minerals essential for the body’s defence mechanism. A diet deficient in these reduces ability of the airways to withstand the ravages of cigarette smoke and other air pollutants.

Foods that are craved are ones often causing sensitivity. Among problem foods are: milk, corn, wheat, eggs, nuts, chocolate, all dairy products, fat of meats. Check labels for tartrazine artificial colouring.

Salt intake. Linked with chest diseases. “Those who eat a lot of salt had more sensitive airways than those with low salt intake . . . excess salt tended to cause most pronounced symptoms.” (Institute of Respiratory Diseases, Oavia, Italy)

Asthma mortality could be significantly reduced by sufferers lowering their salt consumption, an epidemiologist predicted.

Supplements. Daily. Vitamin B6 50-100mg. Vitamin C 500mg. Vitamin E 400iu. Magnesium, Zinc. Cod liver oil: 2 teaspoons.

Anti-allergic bedding. Provides a protective barrier against the house dust mite on mattresses and bedding. Droppings from the tiny pests are worse in the bedroom. ... asthenia

Mouse-ear hawkweed. Hieracium pilosella L. Dried herb. Keynote: cough. Constituents: flavonoids, coumarin.

Action: antitussive, anticatarrhal, expectorant, diuretic, sialogogue, antispasmodic, astringent, antibiotic (fresh plant only). A drying agent for profuse mucous discharge.

Uses: whooping cough, cough productive of much mucus. Profuse catarrh, haemoptysis (blood in the sputum), brucellosis (Malta fever), colitis. Bruised fresh plant used by Spanish shepherds for injuries in the field. Nosebleeds. Liver disorders.

BHP (1983) combination: Mouse-ear, White Horehound, Mullein and Coltsfoot (whooping cough). Preparations. Average dose: 2-4 grams, or equivalent; thrice daily (5-6 times daily, acute cases). Works best as a tea or in combination of teas rather than in alcohol.

Tea: 1-2 teaspoons to each cup boiling water; infuse 15 minutes; dose, half-1 cup.

Liquid Extract: 30-60 drops, in water.

Home tincture: 1 part to 5 parts 45 per cent alcohol (Vodka, gin, etc). Macerate 8 days, shake daily.

Filter. Dose: 1-3 teaspoons in water.

Powder. 500mg (two 00 capsules or one-third teaspoon). ... mouse-ear

Loss of blood from the circulatory system caused by damage to the blood vessels or by a bleeding disorder. Bleeding may be visible (external) or concealed (internal). Rapid loss of more than 10 per cent of the blood volume can cause symptoms of shock, with fainting, pallor, and sweating.

The speed with which blood flows from a cut depends on the type of blood vessel damaged: blood usually oozes from a capillary, flows from a vein, and spurts from an artery. If an injury does not break open the skin, blood collects around the damaged blood vessels close under the skin to form a bruise.

Any lost blood that mixes with other body fluids such as sputum (phlegm) or urine will be noticed quite readily; bleeding in the digestive tract may make vomit or faeces appear darker than usual.

Internal bleeding may not be discovered until severe anaemia develops.... bleeding

A form of bronchitis that develops suddenly but usually clears up within a few days.

It is usually due to a viral infection.

Bacterial infection of the airways may occur as a complication.

Smokers, babies, elderly people, and those with lung disease are particularly susceptible.

The main symptoms are wheezing, shortness of breath, and a cough that produces yellow or green sputum.

There may also be pain behind the sternum (breastbone) and fever.

Symptoms may be relieved by drinking plenty of fluids and inhaling steam or using a humidifier.

Most cases clear up without further treatment, but acute bronchitis may be serious in people who already have lung damage.... bronchitis, acute

A symptom, medically known as haemoptysis, that is caused by rupture of a blood vessel in the air-ways, lungs, nose, or throat. The coughed-up blood may appear as brightred or rusty-brown streaks, clots in the sputum, a pinkish froth, or, more rarely, blood alone. In all cases, medical assessment is needed. Many disorders can cause haemoptysis. The most common are infections, such as pneumonia or bronchitis; and congestion in and rupture of blood vessels in the lungs due to heart failure, mitral stenosis, or pulmonary embolism. A cancerous tumour can also produce haemoptysis by eroding the wall of a blood vessel.

Investigations into coughing up blood include chest X-ray, and, in some cases, bronchoscopy. In about a 3rd of cases, no underlying cause is found. Treatment depends on the cause.... coughing up blood

Inflammation of the larynx.

Laryngitis may be acute, lasting only a few days, or chronic, persisting for a long period.

Acute laryngitis is usually caused by a viral infection, such as a cold, but can also be due to an allergy.

Chronic laryngitis may be caused by overuse of the voice; violent coughing; irritation from tobacco smoke, alcohol, or fumes; or damage during surgery.

Hoarseness is the most common symptom and may progress to loss of voice.

There may also be throat pain or discomfort and a dry, irritating cough.

Laryngitis due to a viral infection is often accompanied by fever and a general feeling of illness.

If sputum (phlegm) is coughed up, or if hoarseness persists for more than 2 weeks, medical advice should be sought.... laryngitis

A cancerous tumour of the pharynx. Pharyngeal cancer usually develops in the mucous membrane lining. In the West, almost all cases of pharyngeal cancer are related to smoking and to drinking alcohol. The incidence rises with age, and the disorder is more common in men.

Cancerous tumours of the oropharynx (the middle section of the pharynx) usually cause difficulty swallowing, often with a sore throat and earache. Bloodstained sputum may be coughed up. Sometimes there is only the feeling of a lump in the throat or a visible enlarged lymph node in the neck. Cancer of the laryngopharynx (the lowermost part of the pharynx) initially causes a sensation of incomplete swallowing, then a muffled voice, hoarseness, and increased difficulty in swallowing. Tumours of the nasopharynx have different causes.Diagnosis of cancer of the pharynx is made by biopsy, often in conjunction with laryngoscopy, bronchoscopy, or oesophagoscopy.

The growth may be removed surgically or treated with radiotherapy.

Anticancer drugs may also be given.... pharynx, cancer of

A serious infectious disease that is caused by the bacterium YERSINIA PESTIS. It mainly affects rodents but can be transmitted to humans by flea bites. There are 2 main types: bubonic and pneumonic plague. Bubonic plague is characterized by swollen lymph glands (called “buboes”). Symptoms usually start 2–5 days after infection, with fever, shivering, and severe headache. Soon, the smooth, red, intensely painful buboes appear, usually in the groin. There may be bleeding into the skin around the buboes, causing dark patches.Pneumonic plague affects the lungs and can spread from person to person in infected droplets expelled during coughing. Symptoms are severe coughing that produces a bloody, frothy sputum and laboured breathing. Without early treatment, death is almost inevitable.

A sample of fluid from a bubo, or a sputum sample, is taken to confirm the diagnosis.

Possible treatments include streptomycin and tetracycline drugs.... plague

An intestinal disorder causing failure to absorb nutrients from food. (See also sprue, tropical; coeliac disease.)

sprue, tropical A disease of the small intestine that causes failure to absorb nutrients from food. It occurs mainly in India, the Far East, and the Caribbean. Sprue leads to malnutrition and megaloblastic anaemia. It may be due to an intestinal infection. Symptoms include appetite and weight loss, an inflamed mouth, and fatty diarrhoea. Diagnosis is confirmed by jejunal biopsy. Sprue responds well to antibiotic drug treatment and vitamin and mineral supplements. sputum Mucous material produced by cells lining the respiratory tract. Sputum production may be increased by respiratory tract infection, an allergic reaction (see asthma), or inhalation of irritants.... sprue

An infestation of humans, usually children, with the larvae of TOXOCARA CANIS: a small, threadlike worm that lives in the intestines of dogs. Children who play with an infested dog or soil contaminated with dog faeces, and who then put their fingers in their mouths, may swallow some of the worm eggs. The eggs hatch in the intestines, and the released larvae migrate to organs such as the liver, lungs, brain, and eyes. Usually, infestation causes mild fever and malaise, which soon clears up; but heavy infestation may lead to pneumonia and seizures. Loss of vision may occur if larvae enter the eye and die there.

A diagnosis is made from sputum analysis, and by a liver biopsy. Severe cases require treatment in hospital with tiabendazole and an anticonvulsant drug.... toxocariasis

An infectious disease, commonly called , caused in humans by the bacterium MYCOBACTERIUM TUBERCULOSIS. is usually transmitted in airborne droplets expelled when an infected person coughs or sneezes. An inhaled droplet enters the lungs and the bacteria begin multiplying. The immune system usually seals off the infection at this point, but in about 5 per cent of cases the infection spreads to the lymph nodes. It may also spread to other organs through the bloodstream, which may lead to miliary tuberculosis, a potentially fatal form of the disease.

In about another 5 per cent of cases, bacteria held in a dormant state by the immune system become reactivated months, or even years, later. The infection may then progressively damage the lungs, forming cavities.

The primary infection is usually without symptoms. Progressive infection in the lungs causes coughing (sometimes bringing up blood), chest pain, shortness of breath, fever and sweating, poor appetite, and weight loss. Pleural effusion or pneumothorax may develop. The lung damage may be fatal.

A diagnosis is made from the symptoms and signs, from a chest X-ray, and from tests on the sputum. Alternatively, a bronchoscopy may also be carried out to obtain samples for culture.

Treatment is usually with a course of 3 or 4 drugs, taken daily for 2 months, followed by daily doses of isoniazid and rifampicin for 4–6 months. However, bacteria are increasingly resistant to the drugs used in treatment, and others may have to be used and treatment carried out for a longer period. If the full course of drugs is taken, most patients recover.

can be prevented by BCG vaccination, which is offered routinely at birth or age 10–14.

Any contacts of an infected person are traced and examined, and, if infected, are treated early to reduce the risk of the infection spreading.... tuberculosis

A rare disorder in which granulomas (nodular collections of abnormal cells), associated with areas of chronic tissue inflammation due to vasculitis, develop in the nasal passages, lungs, and kidneys. It is thought that the condition is an autoimmune disorder (in which the body’s natural defences attack its own tissues). Principal symptoms include a bloody nasal discharge, coughing (which sometimes produces bloodstained sputum), breathing difficulty, chest pain, and blood in the urine. There may also be loss of appetite, weight loss, weakness, fatigue, and joint pains.

Treatment is with immunosuppressant drugs, such as cyclophosphamide or azathioprine, combined with corticosteroids to alleviate symptoms and attempt to bring about a remission.

With prompt treatment, most people recover completely within about a year, although kidney failure occasionally develops.

Without treatment, complications may occur, including perforation of the nasal septum, causing deformity of the nose; inflammation of the eyes; a rash, nodules, or ulcers on the skin; and damage to the heart muscle, which may be fatal.... wegener’s granulomatosis

(COPD, chronic obstructive airways disease) a disease of adults, especially those over the age of 45 with a history of smoking or inhalation of airborne pollution, characterized by airflow obstruction that is not fully reversible. The disease has features of *emphysema, chronic *bronchitis, and asthmatic bronchitis. It is now diagnosed, according to the *GOLD guidelines, at different stages:

Stage 0: the presence of risk factors and symptoms (e.g. cough and wheeze) with normal *forced expiratory volume in 1 second (FEV1).

Stage 1: FEV1 is normal, but the ratio of FEV1 to forced *vital capacity (FVC) is less than 70%.

Stage 2: FEV1 is less than 80% but more than 50% of the predicted value for the patient’s age and height.

Stage 3: FEV1 less than 50% but more than 30%.

Stage 4: FEV1 less than 30% or the presence of chronic respiratory failure.

The guidelines for COPD recommend different treatment regimens for different stages. Although the response to inhaled corticosteriods is less for COPD than for asthma, these drugs, especially combined with inhaled long-acting beta agonists (e.g. *salmeterol), can improve quality of life and survival in stages 3 and 4. There is also a decrease in the number of acute exacerbations of COPD (AECOPD): increased sputum volume or purulence and/or breathlessness, with or without symptoms (e.g. cough, wheeze, chest pain, malaise, fever).... chronic obstructive pulmonary disease