Respiratory infections are very common now a days either acute or chronic. These infections are the major cause of morbidity and mortality, throughout the world. Patients of extreme age of life or with pre-existing lung disorders or immune suppression, etc. are at particular risk.From the beginning of the pandemic, COVID’19 caused by SARS coV-2, is one of the leading causes of morbidity and mortality and a threat to our population and always arises questions towards our health system and quality of life. Homoeopathy, itself has a significant role of treating the various types of respiratory disorders unless and until too much complicated, with the help of individualized homoeopathic medicines following the principles of homoeopathic philosophy. This article tries to help the homoeopathic physician to manage the patients of respiratory disorders in a better way.
KEYWORDS: Respiratory infections, Morbidity, Mortality, COVID’19, SARScoV-2, Quality of life, Homoeopathy, Individualized medicine, Homoeopathic philosophy.
ABBREVIATIONS: Acute lower respiratory infections (ALRI); Upper respiratory tract infection (URTI); Lower respiratory tract infection (LRTI); Respiratory syncytial virus (RSV); Chronic obstructive pulmonary diseases (COPD), coronavirus disease 2019 (COVID’19), severe acute respiratory syndrome (SARS)
INTRODUCTION: ALRI among children in rural India is high and RSV is a significant contributor. ALRI are the largest and single infectious cause of death among children worldwide, with 1-2 million under five deaths and 12 million hospitalizations globally. In India, 17% of all deaths in children < 5 years old are due to pneumonia.1 According to post neonatal mortality estimates, LRTI causes 20% of death with RSV and influenza virus being the most common about 9.5%.2
Respiratory infections are of two types according to their location- URTI and LRTI (below the level of larynx). URTI includes acute coryza (common cold), acute laryngitis, acute laryngo-tracheobronchitis (croup), acute epiglottitis, acute bronchitis and tracheitis, influenza. lrti mainly include infections (pneumonia, bronchitis, tracheitis, etc.); chronic obstructive pulmonary diseases; restrictive pulmonary diseases (parenchymal, pleural or neuromuscular); pulmonary vascular diseases and malignancy.3
- Viruses are the most common causes of upper respiratory illnesses.3
Table no-1: Predominant viruses in respiratory infections1
|Virus||Varieties: types, serotypes, genotypes and others|
|Rhinovirus||Species A,B and C: > 101 serotypes|
|Corona virus||Alpha: 229E, NL63; Beta: OC43, HKU1, SARS, MERS, SARScoV-2|
|RSV||A and B groups; genotypes and lineage|
|Metapneumovirus||A and B groups; genotypes|
|Influenza||Types A, B and C; subtypes AH1-3, N1-2; several strains|
|Others||Hanta virus, enterovirus, measles, chicken pox, cytomegalovirus|
- Bacteria are responsible for the hospital and community acquired pneumonia in adults and also Chlamydia, Coxiella and Mycoplasma are less common causes of severe pneumonia. Infections by Mycobacterium tuberculosis, Atypical mycobacteria and Fungi results in chronic diseases of respiratory system.3
Table no-2: Categories of respiratory diseases4
|Obstructive lung diseases||Asthma Chronic obstructive pulmonary diseases (COPD) Bronchiectasis Bronchiolitis|
|Restrictive pathophysiology- Parenchymal diseases||Idiopathic pulmonary fibrosis (IPF) Asbestosis Desquamative interstitial pneumonitis (DIP) Sarcoidosis|
|Restrictive pathophysiology- Neuromuscular weakness||Amyotrophic lateral sclerosis(ALS) G B Syndrome|
|Restrictive pathophysiology- Chest wall /pleural diseases||Kyphoscoliosis Ankylosing spondylitis Chronic pleural effusions|
|Pulmonary vascular diseases||Pulmonary embolism Pulmonary arterial hypertension (PAH)|
|Malignancy||Bronchogenic carcinoma ( non-small cell and small cell) Metastatic disease|
|Infectious diseases||Pneumonia Bronchitis Tracheitis|
Past history: Tuberculosis, any allergic illness-specially naso-bronchial illness, childhood illness- measles, tuberculosis, whooping cough, exposure to STD, occupation in cold mines, asbestos mines, silica factory, cotton dust, etc. Chest injury. Any H/o unconsciousness which predisposes aspiration and lung abscess.
Family history: Tuberculosis, bronchial asthma, allergic illness, eczema, emphysema.
Personal history: Smoking, substance abuse, contacts with pets or exposure to allergens.
Treatment history: Anti tuberculous drugs, corticosteroids, immunosuppressants, bronchodilators or cytotoxic drugs.
CLINICAL PRESENTATIONS: 3,4,5
- Coryza, sneezing, obstruction of nose, sore throat, hoarseness, stridor, breathlessness, pyrexia associated with generalised aches and pains etc. ( common cold, acute laryngitis, croup, acute epiglottitis, acute bronchiolitis and tracheitis, influenza, etc.)
- Cough (pulmonary tuberculosis, bronchiectasis, lung abscess, lobar pneumonia, heavy smoker or bronchogenic carcinoma).
- Expectoration or sputum production (bronchiectasis, lung abscess, resolution stage of pneumonia, chronic bronchitis).
- Haemoptysis (tuberculosis, bronchiectasis, lung abscess, pneumonia, bronchogenic carcinoma).
- Chest pain (pleurisy, spontaneous pneumothorax, acute tracheobronchitis, Ppulmonary thromboembolism).
- Breathlessness or dyspnoea (bronchial asthma, COPD, consolidation, pneumothorax, pleural effusion, fibrosing alveolitis, ARDS).
- Wheezing or stridor (bronchial asthma or COPD for wheezing, and laryngeal oedema or aspiration of foreign body for stridor).
a. Heaviness in the chest (in pleural effusion, pneumothorax or hydropneumothorax, the affected side of chest feels heavy).
b. Fever (tuberculosis, pleurisy, lung abscess, pneumonic consolidation, and lower respiratory tract infection/LRTI).
c. Hoarseness of voice (laryngitis, diphtheria, angioedema, vocal abuse and especially, due to recurrent laryngeal nerve palsy from bronchogenic carcinoma).
d. Loss of weight and/or loss of appetite (tuberculosis, lymphoma or bronchogenic carcinoma) or night sweats (tuberculosis or lymphoma).
e. Swelling of feet or oedema (in chronic cor pulmonale, e.g., right ventricular failure from COPD).
EXAMINATION OF RESPIRATORY SYSTEM:6
- Examination of the upper respiratory tract (URT): Nose and alae nasi, nasal cavity, oral cavity, paranasal air sinuses, pharynx, mouth breathing, purse-lip respiration, larynx (examined by laryngoscope).
- Examination of the chest (LRT).
- Shape of chest (barrel-shaped in emphysema, pigeon-shaped in rickets, alar chest in tall-thin person, or funnel chest in cobblers)
- Movement of the chest
- Apical impulse, venous prominence (should be examined in standing or sitting position of the patient after a bout of cough)
- Fullness or depression in the chest- unilateral or bilateral, localised or generalised
- Respiration- types
- Accessory muscles of respiration, intercostal suction, wheezing or stridor
- Skin: Gynaecomastia, ulcer, sinus, pigmentation, any swelling (i.e., cold abscess from tuberculosis), parietal oedema
- Back: kyphoscoliosis, gibbus, ‘straight back’, drooping of the shoulder, winging of the scapula, arterial or venous pulsations, skin conditions.
- Surface temperature and tenderness
- Corroboration of the findings of inspection, e.g., chest symmetry, spinal deformity, direction of venous flow, position of apical impulse, etc.
- Position of the trachea and apex beat
- Movement of the chest (to find out the symmetry of movement and expansion of the chest)
- Vocal fremitus and other tactile fremitus.
C. Percussion: Conventional percussion, shifting dullness, coin percussion, detection of hepatic and cardiac dullness, traube’s space percussion.
- Breath sounds (vesicular or bronchial)
- Vocal resonance (increased or diminished, whispering pectoriloquy, aegophony)
- Adventitious sounds (wheezes or rhonchi, crackles or crepitations, pleural rub)
- Others: Succussion splash (splashing sound heard in hydropneumothorax), post-tussive suction, pneumothorax click, tinkling crepitations).
INVESTIGATION: Chest x-ray (PA view provides information on the lung fields, heart, mediastinum, vascular structures and thoracic cages); CT scan (HRCT); Ventilation- perfusion imaging; PET scan; pulmonary angiography; endoscopic examinations ( laryngoscopy, bronchoscopy); pleural aspiration and biopsy; skin tests (tuberculin test, skin hypersensitivity tests); immunological and serological tests; microbiological investigations (sputum, pleural fluid, throat swab, blood and bronchial washings aspirates can be examined for bacteria, viruses and fungi); histopathological and cytological examinations; respiratory function testing, etc.3,4
It is based on the clinical presentations, general examinations, respiratory system examinations, predisposing factors and different investigations or as per need of the cases.
General management should be given as per need of the conditions of the patients.
Homoeopathic approach: As every disease (not entirely surgical) manifested through sign and symptoms due to dynamic alteration of vital energy, so in every homoeopathic cure this life principle dynamically deranged by natural disease is seized through the proper administration of indicated remedy applied on the basis of symptom similarity6. Hahnemann said that the totality that is the sum total of the sensations and observable changes in the organism, which constitute the concrete problem in every case with which we have to deal, no matter what the name bears it.7
Miasmatic approach: During the evolution of the discovery of chronic disease, Hahnemann came to the conclusion that the disease condition cannot arise, persist or even grow worse if the miasm is not present.8 It took Hahnemann several years to understand the theory of the miasms and he wrote brilliantly on psora but relatively very little on syphilis and sycosis.9 Psora is the beginning of all sickness. ‘Had psora never been established as a miasm upon the human race, the other two chronic diseases would have been impossible and susceptibility of acute disease would have been impossible’.10 Three forms of alternations of cellular functions can be imagined: deficiency – psora, excess – sycosis, perversion – syphilis.11Any forms of respiratory complaints-asthma, ulceration of lungs, haemoptysis all are under psoric miasm.12 Frequent attacks of dyspnoea, short cough < morning, predisposition to catch cold easily-due to latent psora. Coryza, cough, sneezing, hoarseness from slight exposure to cold. Cough with or without haemoptysis; with excessive expectoration of mucus and sinking in strength Asthma lasting several weeks.6
Dyspnoea <: ascending high altitudes. No difficulty in descending due to syphilitic miasm.13 The suppressed gonorrhoeal infection is very first affects the blood and producing anaemia, and a general catarrhal condition.14
ACONITUM NAPELLUS: Constant pressure in left chest; oppressed breathing on least motion(asthma). Hoarse, dry, croupy cough(bronchitis); loud, laboured breathing(pneumonia). Child grasps at throat every time he coughs(whooping cough). Very sensitive to inspired air. Stitches through chest(pleurisy, pleurodynia). Cough, dry, short, hacking; worse at night and after midnight.
ANISUM STELLATUM: Dyspnoea. Pain near right third intercostal cartilage. Cough, with pus-like phlegm. Palpitation, with aphthae. Haemoptysis.
ARALIA RACEMOSA: Asthma on lying down at night with spasmodic cough; worse after first sleep. Obstruction worse in spring. Hay-fever; frequent sneezing.
ARSENICUM ALBUM: Unable to lie down; fears suffocation. Asthma worse midnight; worse lying on back. Expectoration scanty, frothy. Darting pain through the upper third of right lung. Haemoptysis with pain between the shoulders.
BACILLINUM: Catarrhal dyspnoea. Humid asthma. Bubbling rales and muco-purulent expectoration. Often relieves congestion of the lungs, thus paving way for other remedies in Tuberculosis.
BRYONIA ALBA: Cough, dry at night; must sit up; worse after eating or drinking, with vomiting, with stitches in chest, and expectoration of rust-coloured sputa. Cough, with feeling as if chest would fly to pieces; presses his head on sternum; must support chest. Coming into warm room excites cough.
CARBO VEGETABILIS: Spasmodic cough, bluish face, offensive expectoration, neglected pneumonia. Breath cold; must be fanned. Haemorrhage from lungs. Asthma in aged with blue skin.
CROTALUS HORRIDUS: Cough, with bloody expectoration. Tickling from a dry spot in larynx.
CUPRUM METALLICUM: Cough as a gurgling sound, better by drinking cold water < worse 3 am. Angina with asthmatic symptoms and cramps.
DULCAMARA: Cough worse cold, wet weather, with free expectoration, tickling in larynx. Winter coughs, dry, teasing. Asthma with dyspnœa. Loose, rattling cough; worse wet weather. Must cough a long time to expel phlegm.
HEPAR SULPHURICUM: Cough troublesome when walking. Dry, hoarse cough. Cough excited whenever any part of the body gets cold or uncovered, or from eating anything cold. Croup with loose, rattling cough; worse in morning. Anxious, wheezing, moist breathing, asthma worse in dry cold air; better in damp.
GRAPHITES: Spasmodic asthma, suffocative attacks wakes from sleep; must eat something.
GRINDELIA ROBUSTA: Asthma, with profuse tenacious expectoration, which relieves. Stops breathing when falling asleep.
ICTODES FOETIDA: Spasmodic croup. Troublesome respiration, with sudden feeling of anguish and sweat. Sneezing, with pain in throat. Asthma; relieved by stool.
IODIUM: Right-sided pneumonia with high temperature. Hepatization spreads rapidly with persistent high temperature; absence of pain in spite of great involvement.
IPECACUANHA: Cough incessant and violent, with every breath. Bubbling rales. Bleeding from lungs, with nausea; feeling of constriction; rattling cough. Croup. Hæmoptysis from slightest exertion.
KALIUM CARBONICUM: Dry, hard cough about 3 am. Bronchitis, whole chest is very sensitive. Expectoration scanty and tenacious, but increasing in morning and after eating; aggravated right lower chest and lying on painful side.
KALIUM IODATUM: Expectoration like soap-suds, greenish. Pneumonia, when hepatisation commences. Dyspnoea on ascending, with pain in heart.
LAUROCERASUS: Cyanosis and dyspnoea; worse, sitting up. Patient puts hands on heart. Cough, with copious, jelly-like, or bloody expectoration. Small and feeble pulse. Threatening paralysis of lungs.
LOBELIA INFLATA: Senile emphysema.
LYCOPODIUM CLAVATUM: Cough worse going downhill. Cough deep, hollow. Expectorations gray, thick, bloody, purulent, salty. Chest seems full of mucus rattling. Neglected pneumonia, with great dyspnoea, flaying of alae nasae and presence of mucous rales.
MANGANUM ACETICUM: Tuberculosis of larynx. Cough; worse evening, and better lying down and worse in damp weather. Haemoptysis. Every cold rouses up a bronchitis.
MEDORRHINUM: Asthma. Incipient consumption. Dyspnoea, cannot exhale. Cough; better lying on stomach and worse from sweet.
MERCURIYS SOLUBILIS: Soreness from fauces to sternum. Cannot lie on right side. Cough, with yellow muco-purulent expectoration. Paroxysms of two; worse, night, and from warmth of bed. Stitches from lower lobe of right lung to back. Whooping-cough with nosebleed. Cough worse, tobacco smoke.
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ABOUT THE AUTHORS:* Dr Biswajit Bera, BHMS(H), currently pursuing MD (Hom.) PART-II; Dept of Practice of Medicine, CHMC&H; KOLKATA, WB.  Dr Reshmita Ghosh, BHMS, M.O. (RBSK), Dept. of AYUSH, currently attached with Vidyasagar BPHC, GHATAL, PASCHIM MEDINIPUR, WB.