Keshav Apte 35 yrs, Shop Owner in Calcutta, was a Asthma patient for last 10 years, maintained on inhaler therapy. He worsened
one winter & was put on steroid therapy. He found good relief but developed avascular necrosis of his left femur head
of his Left Hip. He now limps for life. His asthma did not abate & kept recurring as soon as the medicines was stopped.
He started Nature therapy and within 6 months, all his breathlessness vanished. The limp has reduced considerably and he is
on his way to recovery.
Within one hour of reaching the lungs, the bacilli are captured by the
lymph nodes at the hilum and neutrophils begin phagocytosis.
Then macrophages take over and 4 weeks later T-cell mediated immunity takes over forming a granuloma, in the centre
of which there is necrotic caseation of bacilli.
After central caseation there is a concomitant rise in resistance and in the ability of inhibition of intracellular
replication of tubercle bacilli. Hence disseminated Miliary TB is very rare.
Caseation heals with calcification and fibrosis. Only when chronic ill
health makes the immunity wane, reactivation in the lung may occur. The caseated
cavity ruptures or empties into the bronchus and is naturally drained.
A pleural Effusion may develop because of immunological
reaction. Removal of this fluid appears to be only psychologically beneficial
as removal of 1-litre results in only less than 500 ml of lung volume expansion.
The allergen attaches to IgE antibody and this complex attaches to the
mast cells and ruptures it, releasing lysozymes.
Bradykinin, Serotonin, Histamine, Heparin and slow reacting substances of anaphylaxis, which cause bronchospasm and
vascular congestion and oedema to reduce the antigenic input. Eosinophils then
migrate to the allergic tissues, after signals from the mast cells and detoxify the mediators and phagocytose the antigen
Increased mucus production occurs due to increased capillary permeability and plasma exudes out into the airway lumen
and viscid balls of mucus are formed which are expelled out after the attack subsides.
The specific IgE antibodies are produced for specific antigens. 40% of
patients the attacks become less frequent and less severe and in 20% complete remissions can occur.
The Endogenous corticosteroids increase four fold and block some of the inflammatory effects of the AgAb reaction without
interfering with the immune complex destruction. There is macrophage activation,
release of TNF and IL’s, which triggers inflammation.
The mild asthmas are managed by the mast cells and severe asthmas by the B-lymphocytes and IgE.
There is T lymphocyte activation in addition which via CMI and cytokines increases the lifespan of eosinophils.
Epithelial cells are shed and give easy access of inflammatory cells from capillaries to allergan in the airway and
in addition epithelial cells release intercellular adhesion molecule.
ICAM-II, which captures the AgAb complex within the epithelial cell before being shed out. The nerve endings are exposed
and Neuropeptides are released which in turn increase the permeability and mucus formation.
Dr.Michael Abramson Monash University in Melbourne, Australia after
studies on Asthmatics reports that high blood levels of salbutamol were more
than twice as high in dying patients than in surviving patients.
IgE Antibodies to common environmental materials/pollutants are present in 30-40 % of population , many asymtomatic,
this shows that a large majority overcome allergies by beneficial antibody response.
Type I is hypoxic and Type II is hypercapnic (+ decreased PO2)
Various compensatory mechanisms exist, as outlined
(1) High output state by the heart.
(2) HCO3 retention by the kidney corrects the acidosis.
(3) Alterations in tidal volume, respiratory rate and changes
in pressure of inspired air by use of accessory respiratory muscle are all dictated by the respiratory centre.
(4) In fact the condition of respiratory alternans denotes
a breath to breath alteration in the relative contribution of intercostal muscles and the diaphragm.
(5) In ventilators volume, pressure, O2% and Resp rate can
all be set by by passing the wisdom of the respiratory centre and in addition posing a problem of weaning from the ventilator
as the patient has long forgotten how to breathe effectively on his own after the dependence on the ventilator.
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