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THE BREATHING SYSTEM

We 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

calledbreathing?

How does it happen?What in our body helps us

to breathe?What are the illnesses thatcan affect our breathing?

In this lesson, we will learnabout organs that help us to

Our Breathing System

Organs in our body that help in Breathing

Starting 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.

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nose

throat

voice box

wind pipe

lungs

bronchus

diaphragm

NOSE

What is the nose made up of?The upper part of the nose is partially made of bone while the lower part ismade 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 producesticky fluid, but much of such fluid also comes from the air sinuses in thebones – read below – around the nose that open into the cavity of the nose.

You Cannot Cure A Cold !A cold cannot be cured! There is no medicine made till date thatcan cure a common cold. Since it is due to an attack of a tinygerm – a virus – we should remember that the nose is trying tothrow it out by bringing out a lot of sticky fluid or mucous.

When we have a cold, instead of taking some tablets ot medicineimmediately, we should take plenty of hot fluids and keep a clothhandy to wipe our nose. Some ‘cold medicines’ may bring relieffrom a bit of fever and headache, but are also likely to delay thecure !

Why does our Nose leak?When the air is too cold or too hot,the nose tries to bring out some stickyfluid. The air that we breathe will haveto pass through this fluid and henceits temperature will come closer to thebody temperature. Too much of fluidmay come out to make our nose leakor we sniffle.

Also, when we have a cold lots ofsticky fluid is produced. This helpswash off the germs that might troubleus if they got inside our lungs.

The sneeze reflex, an automatic reac-tion by which the nose throws out withgreat force what irritated it, also keepsharm away from the lungs.

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What does the Nose Do?1. Our nose cleans the air we breathe in. It nosestands guard to see that the air that enters our body isdust free. Smal hair at the entrance of the nose filtersthe dust from the air before allowing it to pass inside.

2. Trapping Germs: The sticky fluid traps germs sothat it does not enter our lungs.

3. . It warms the air: Apart from cleaning the air,the nose also makes the temperature of the air accept-able to the body before it allows this air to reach ourlungs.

4. Our nose helps us smell: The nose also helps usto smell, a function that is more useful to the digestivesystem, because it starts the regular digestive wave inthat system.

SINUSESWhy 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, theyalso 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.

The biggest sinusesare those inside ourcheeks. Theopenings of thesesinuses are veryhigh and it isdifficult for them tobe emptied easily.So, we get a feelingof heaviness aroundour nose and belowour eyes when wehave a cold.

tonsils

throat

The 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.

Infection of the throat leads to pain in the throat anddry cough. If the germs have infected the part joiningthe food pipe, we are likely to find difficulty inswallowing. If it has infected the front part (the partjoining the windpipe) or the voice box that has vocalcords to bring out our typical voice – our voice is likelyto change and we may also end up being voiceless.

THROAT

Ask your neighbour to open hermouth and ask her to say“aaaaaa………” . You can see most ofthe throat including the tonsils

The Throat

sinus

What to do in Sinus Infection?Heaviness in the head, pain over the cheeksand a stuffy nose following a cold tell usabout the infection of the sinuses. To feelbetter, heat some water in a pan and breathein its vaopur.

Then, bend your head forward, tilt it to oneside and blow firmly to empty the sinus. Dothe same on the other side.

Take hot drinks like tea, coffee or soups. Inhaling vapour is the bestand cheapest remedy for most illnesses of the breathing system.

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VOICE BOX

The voice box or the larynx (la-rinks) is that portionof the front of our neck that juts out, and can be seenmore prominently in men. The windpipe begins fromjust below this.

The voice box has a fold of lining on either side thatcan stretch or relax. These folds – also called vocalcords by either stretching or relaxing – can make the

difference 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 resultin 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 salesmanlose 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, wecan 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 hotvapour, we will need to retrain our vocal cords by trying to sing out aloud. For infections,along with breathing vapour, antibiotics may be necessary.

WINDPIPEThe windpipe – or trachea (tray-keah) - starts from below thevoice box and ends where itdivides into two bronchi (single-bronchus). You can see rings inits entire length. These are bandsof cartilage. They stop thewindpipe from collapsing when

air is drawn in.

Infections of the windpipe usually go alongwith infections of the voice box. If the liningswells up, cough results. This cough is usuallydry. We may also feel breathless and a strangesound is produced every time air passesthrough the windpipe blocked by the swollenand infected lining.

Knowledge You CanUseIf a sick person withbreathlessness produces asound, try to clearly makeout if the sound is

produced while breathing in orbreathing out.

In swellings of the voice box and thewind pipe, we may hear sounds whilethe person is breathing in air. But ifthe sound is accompanied bybreathlessness when breathing air out,the illness is clearly that of thebreathing system below the windpipe!

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voice box

Long-Standing CoughsWhen we are exposed to tobacco or other smoke for manyyears, the lining of our bronchus tends to lose its finger likestructures and cannot produce sticky substance. As a result,outside dust and germs are no longer trapped and can causetheir harm deep inside.

BRONCHUSBronchus is the pipe that carries air below the wind pipe right tothe lungs. It branches left and right of the windpipe and ends intovery 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 LiningThe bronchus has a lining inside justlike the windpipe, and also has somesmooth muscle in its wall. This musclecannot be moved whenever we want,but squeezes or relaxes automaticallywhen we breathe in or breathe out.The brain directly controls thesemuscles depending on how much ofoxygen is required for the body.

Sweeping away the GermsThe bronchus lining has tiny finger-like structureswhich act like small brooms. They keep swayingfrom one side to the other at all times. Just like thewindpipe and the nose above, they also have stickyfluid on it. Outside substances like soot, dust orgerms stick to this. And in this swaying movement,the things that have stuck are handed over fromone finger like structure to the previous one andto the next previous one until they can be coughedout!

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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.

The two lungs are made ofcountless small roundgrape like structures, al-veoli. Through these, oxy-gen coming in through ourbreathe is given to the bloodin the capillaries.

The grape like structuresalso allow carbon dioxidebrought by the blood fromthe far off parts of the bodyto get thrown into thebronchi and later to bebreathed out of the system.

The diaphragm is a musclebetween the chest and the ab-domen. It moves down-wards16 to 20 times a minute.

The lungs have manysmaller sections;each called a lobeand supplied bysmall bronchi thatbranch off inside tosmaller bronchi andbronchioles.

Usually, in case of aninfection, it is the en-tire lobe that getsswollen – inflamed –and the person canget fever, cough andpain in the part of thechest. This is calledpneumonitis or whatis commonly calledpneumonia.

Protect children from lung infectionsLung infections are the biggest cause of deaths amongchildren below five and especially in babies less thanone year. Poorly nourished, they cannot fight infections.Also, their bodies are too weak to cough out theinfections. We need to protect children from lung infec-tions.

For every child who gets cough, we will have to see thatshe gets early treatment. But it is more important toprevent children from getting cough in the first place. Some of these wouldprotect children from getting lung - and some other common infections.

• We will have to see that they live in houses that arenot crowded.

• Their houses should have enough windows to allow fresh air• Make sure that we have toilets so that children do not step on

eggs of worms when they walk around barefoot and get sick.• Children should get early treatment before they become too

weakto resist other diseases.

• They should get extra food after every illness to help themrecoverthe nourishment they lost by the previous one!

LUNGSThe Lungs are the biggest and most important part of the breathing system.

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lungs

grapelike alveoliThese are pockets of airsurrounded by thetiniest of blood tubescalled capillaries.Diaphragm

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 & Bronchioles

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Know the AnswersThe Breathing System

Please 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.

Diseases of theBreathing System

What You Will Learn In This chapterPage Number

1. Common Cold 2-9 to 2-102. Stuffy Nose 2-103. Coughs

a. what are coughs? 2-11b. types of coughs 2-12c. treatment 2-13

4. 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 2-21b. Earaches & Infections 2-22 to 2-23c. Deafness 2-24

11. Throat Problems 2-24

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A flowing nose and sneezing are signals that a cold has set in.The patients’ eyes may be red and bloodshot. The throat feelssore and a little dry cough may be present. Some may have slightfever 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 soupsevery few hours. You may add ginger and /or Tulsi (Basil) leavesto the tea. Orange or lemon juice are helpful.

3. Gargling with warm salt water may help to soothe the throat.

4. Vapour inhalation may be taken every few hours.

5. If the fever is too troublesome, you may give theperson 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, onemay add half to one tablet of Chlorpheniramine two tothree times daily – but in children avoid it.

Gargle with warm water

DISEASES OF THE BREATHING SYSTEM

The breathing system from the nose to thelungs gives us trouble on a number of occa-sions. From simple illnesses like cold andsneezing to serious ones like pneumonia andTB, we will try to learn more about them inthis section.

For some diseases, we can follow somesimple and cheap steps to cure them. In manywe will learn to give medicines carefully. Inothers we will learn to pick up the signalsearly enough so that our friends and relativesin the village can get cheap and affordabletreatment for them in time.

COMMON COLD

General Principles to keepyour Breathing System fit

The lining of the breathing systemis quite hardy. If it is kept intactand moist it can help us resist mostinfections from viruses and bacteria.This lining can produce a sticky fluidthat traps dust and germs. When thisis produced in large amounts, it evenacts as a filter to clean the air beforeletting it get to our lungs.

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STUFFY NOSEA nose may get stuffy in the latter part of acold or due to allergy. In children themucus can be pulled out from the nose bya small dropper or a syringe (without aneedle).

For bigger children, plain or salted watercan be sniffed into the nose.

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 aresitting together, even if it is cold.

The sick person should eat and sleep separately; he shouldcover his mouth and nose every time he sneezes or coughs.

Eating and sleeping well builds up our resistance andprevents colds from attacking us.

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What NOT to do in a cold?DO NOT take any antibiotics for a cold as they are of no use andmay cause harm. Colds always go away without medicines.

DO NOT waste money on “cold tablets”, they are no better thanParacetamol or Aspirin!

DO NOT blow the nose in a cold; wipe it clean – blowing maypush the cold up the ear and sinuses and cause infection there.

For those who usually get earaches and sinus problems after colds, onemay use Tablets like Chlorpheniramine twice daily. Or they can usenose drops of salt water , which can be put into each nostril three timesa day.

COUGHYou 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 andhas more fluid. The cheapest and simplest method is toinhale water vapour.

Taking any medicine that dries the secretion or suppressesthe cough actually helps germs to trouble us more. Theystay in our organs longer and goes deeper to the inner parts.Scientists still debate if cough syrups are of any use at all.

Inhale Vapour &Cough it out!

Heat some water – no need to boilit – until you can see vapour ris-ing fromit.

B e n dover thepot, coveryour headwith atowel orcloth, andinhale asdeep aspossibles e v e r a ltimes.

The warm vapour will increase thecirculation of the lining inside andhelps it to fight the germs. It alsohelps to make the cough more liq-uid so that it is easier to be coughedout.

Children’s CoughsChildren’s coughs and colds areusually due to viruses and there isno effective medicine to kill theseviruses. Vapour inhalation, goodfood and enough fluids make moresense than costly antibiotics.

We Have More Breathing Dis-eases in WintersBreathing diseases are more common inwinters. This is mainly because we tendto huddle together in the cold and sitcloser to one another in closed rooms.

The chances of sharing our germs in suchplaces become easier. It is better to keep doors and win-dows open at night and ask people to take an extra blan-ket to sleep while sleeping together in a room. Keepingdoors and windows closed throughout the night will pre-vent air circulation. It will increase the chance of spread-ing illnesses to another.

Antibiotics are necessary only if simple coughs andcolds have not got better within seven or ten days orthe person has progressed to other diseases like pneu-monia or TB (see later).

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If at all one takes a cough syrup, see to it that it is marked EXPECTORANT. Avoid anycough syrup that contains cough suppressants like CODEINE, PHOLCODINE,DEXTROMETHORPHAN, etc. For children and the aged, these MUST NEVER be used!

Types of Coughs

Cough 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?

• Smoker’s cough• Worms while passing

through lungs• Cold• Asthma

Cough for longdurations are suggestive of:• Smoker• TB• Asthma• Chronic Bronchitis• Lung with pus pockets

Reasons for Coughs

Cough with breath-lessness and wheezingsound:• Asthma• Whoopingcough/ diph-theria • Heart trouble

Dry Cough (without anyphlegm)• Cold• Worms• Lung infection

like pneumonia• Measles

Cough with Mucus• Bronchitis• Pus diseases of

lung• Pneumonia

Cough with blood:• TB• Pneumonia• Severe worm infection• Cancer• Heart failure

• Allergy• Chronic Bronchitis• Cancers• Rarely in TB• Low fever may

be present in TB

Cough without fever can be be seen in:

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1. For cough with bloodÞ Check if the blood could have come from a bleeding gum or

mouth injury. If there is irritation in the throat as well thenbleeding is from the breathing system. The person needs toget checked for TB – an X-Ray, sputum examination and adoctor’s check up will help.

2. For severe dry coughWITHOUT PHLEGM thatdisturbs sleeping and rest

Þ Give Tablet or syrupwith CODEINE (butnot to the elderly and tochildren below tenyears!). You may giveASPIRIN

Þ Do not give it CO-DEINE if there isphlegm or wheezingsound while breathingin or breathing out.

3. For cough with mucusÞLoosen mucus by drinking lots of water or hotfluids. This is the best - better than any medi-cine.

ÞBreathe hot water vapours. Sit down or standnext to a vessel with hot water. Cover yourself

and the vessel with a sheet of cloth or towel sothat you can breathe the vapours. Breathe deeplyfor 15 minutes. Repeat as many times a day aspossible. This is an excellent remedy for all res-piratory problems.

Þ You can tap the chest from behind for 10 to 15minutes two times a day, especially for old andweak people.

Different Coughs must be treated Differently

Treatment for allcoughs

Þ Grind some Tulsi (Basil)leaves to get a spoonful ofjuice. Mix with one spoon ofhoney and one spoon oflemon/orange juice. Giveevery two –three hours or so.

Þ Give tea with ginger / tulsileaves every few hours

DO NOT ALLOW SMOKING.

• If a small quantity of blood comes out, it will stop on itsown;

• If it is less than 1 or 2 glasses, calm the person and resthim in bed.

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BronchitisBronchitis 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 alsobe used.2. Lower fever with cold compresses or PARACETAMOL;keep giving hot fluids and vapour inhalations.

How do we stop Bronchitis fromspreading to others?

1. Ask the person to cover his mouthwith his hand or handkerchief whilecoughing.

2. Collect the phlegm or mucus on apiece of paper and burn it or bury itwell.

Chronic BronchitisCough with mucus that occurs at least three months a year and keeps coming back everyyear 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 orAsthma(see later), the person has Chronic Bronchitis.

Usually seen in older people and those who have smoked heavily, it can lead to a disease ofthe lungs in which pockets of the lungs break down. In this disease, the person remains out ofbreath all the time.

What to do inChronic Bronchitis?

Þ STOP SMOKINGÞ Take SALBUTAMOL three to four

times a day.Þ Every time there is severe cough with

fever, take antibiotic likeCOTRIMOXAZOLEorDOXYCYCLINEorAMOXYCILLIN

Þ Hot water vapours help a lot andmust be taken at least once a day,especially at night.

DrainingOut PhlegmFor old and weakpeople, help withdraining out thephlegm and pus canbe given. After in-haling vapour, theperson should lie onhis belly on a cotand his chest andhead must lean forward onto the ground hanging overthe edge. Tap on the back to loosen the mucus.

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What not to doin Bronchitis?

Do not rush forantibiotics.

DONOT allowsmoking.

3.Children’s bronchitis are mostly due to a virus.Antibiotics will not help. Only if the bronchitis lasts more thana week and if it is not getting better, or if it is worsening topneumonia, give antibiotics like COTRIMOXAZOLE orAMOXYCILLIN.

Bronchitis- noisy cough; breath-

less

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 morethan three days, start Tablet COTRIMOXAZOLE twicea day.

3. Give lots of fluids to loosen the mucus.

4. For mild attacks, start SALBUTAMOL. If already onSalbutamol, 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 chickenor 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 onSALBUTAMOL 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.

In Asthma attacks,the person findsdiffculty in breathing

Asthma AttacksASTHMAThe 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 inthe lungs reacts to some substances it comes in contact with. Theallergy that causes asthma can be due to various things, like flowerpollen, dust, cold air etc.

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How to know whether it iscommon fever or pneumonia?

Breathing becomes faster even with simplefevers. Therefore, it may be difficult, espe-cially with children, to say if the rapidbreathing is due to simple fever or due topneumonia, which also may give fever.

To differentiate, one should count thebreathing rate and the pulse rate at the sametime. Normally, the pulse is about fourtimes the breathing rate. If the ratio is lessthan four is to one, it is highly likely thatthe problem is not just simple fever, but aproblem with the breathing system, e.g.pneumonia.

PNEUMONIAInflammation 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.

What to do in Pneumonia?1. Start COTRIMOXAZOLE or AMOXYCILLIN in full

doses immediately. If serious, send for help, but afterstarting the treatment.

2. Give PARACETAMOL if fever is high and to lessenpain.

3. Give plenty of hot fluids especially like tea, coffee orsoups. If person is not eating, liquid foods orrehydration drinks may be important.

4. Get the person to breathe hot water vapour. Bodydown

drainage may also help.5. If the person is wheezing, SALBUTAMOL will help.

6. Serious Pnemonia will needinjcetions. Refer the person IM-MEDIATELY to a hospital !

Detecting PneumoniaUsually affecting one part of the lung, pneu-monia should be suspected if a person has:

Cough, often with yellow, greenishor rusty, blood coloured mucusHigh fever (fever may be low inelderly people)Pain in some part of the chest,especially while breathing deeplyDifficulty in breathing, andRapid shallow breathing

Signs of Serious PnemoniaAlong with the above:* If the muscles between the ribs are drawn in (pulledinwards) every time the child breathes

* If the person is unable to eat or drink.

Count breathing of babiesto detect pneumonia fastPneumonia can kill babies veryfast. We should suspectpneumonia and start antibioticsimmediately if:

* A child lessthan onemonthbreathes fiftyshallowbreaths andmore in aminute.

* If a childwho is between 1 monthand 1 year old breathes fortyshallow breaths and morein one minute.

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LEARN TO COUNT THE BREATH

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 (we

want the resting rate to compare with normal people).

Tell the person that you are going to measure her

breathing rate. Keep an eye on your watch for a minute

and count the number of times the person has either

taken in air or thrown it out. Note the figure.

After a while, tell the person that you would like to check

her pulse, and by a side-glance count her breathing rate.

Note it down and compare.

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A 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.

TUBERCULOSIS (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 thelungs. A small but hardy bacterium called Mycobacteriumtuberculosis is present in more than half the people of India beyondthe age of forty. In some of those who have the infection, disease oftuberculosis may occur sometime during their lifetime.

Less than half of all patients who have the TB disease and do nottake any treatment may bring out the germ in their mucus. In dampatmosphere and in congested places, anyone nearby is likely tobreathe in the germ and get infected. In those who are poorlynourished, 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 weight

These 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.

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How do we stop T.B from spreading to others?

ONLY a person with cough show-ing a positive result for TB canspread it to others. Those testingpostive for T.B should:

• Try to sleep in a separate roomor if not possible then sleep in aroom with open windows forventilation

• Cover the mouth while coughing.

• 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 thenext two years the family members should also be under watch for the disease.

What 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 nothelp confirm whether there is T.B or not.

If the person has T.B, medicines should beginimmediately. As there are many schedules of differentmedicines that can be given for TB, request the treatingdoctor to start a schedule that the person can afford.

Different types of drugs are of different costs and an affordable schedule isimportant. If the person starts and stops treatment repeatedly, the germ islikely to get resistant to the usual medicines. It is said that it is better not totreat a person’s TB than to treat halfway! The fastest course to treat T.B requiresfour drugs to be taken for two months followed by four months of two medicinesonly.

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.

T.B spreads through breathing and coughing.Person with T.B should stay in separate room

or a well ventilated room from family.

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ALLERGYThough 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.

Allergy reactions can be mildor serious:

On the skin, the person may getrashes, or lumpy patchesSome may get a stuffy nose and re-peated sneezingIrritation in the throat, which maylead further to difficulty in breathingor an attack of asthma.Allergic shock — the person may col-lapse and his pulse and BP may be verylow.Diarrhoea in some children, whoreact to milk or to wheat products.

What to do for Allergies?

1. Try to find outwhich drug orthing one reactsto and avoidthem.

2. Tab CHLORPHENIRAMINEor PHENIRAMINE twice aday helps in reducing thereaction.

Some Common Things that People develop Allergy Towards

certain foods

some drugs; sulpha; orpenicillin injections

plants or someherbs

some animals likecats, dogs etc.

old and mouldyblankets, pillowsetc

alcoholicdrinks

animalfeathers;fur

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Ear 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.

Pinna

Ear Canal

Ear Drum

Middle Ear

Inner Ear

NerveOuter Ear

- outer Ear endin ear drum

- from ear drum on-wards; has small bones;sends vibrations to innerear; balances pressureon eardrums

- has snail shell; sendssound signals to brain;has tubes which keepbody balance

Half Cirlcle Canalsfor balancing body

Parts in The Human EAR

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Ears

Commonest Places of Ear InfectionsThe ear tube from the middle ear to the throat is the commonest

reason for infections reaching th ear. Especially during colds, ifwe pinch our nose and blow hard, the infection may travelinto the middle ear. Here, there is limited space and if pus hasformed, 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 entersaccidentally while bathing or swimming. Repeated infectionscan spoil the small bones and the middle ear so that the soundfrom the outer ear is not transferred to the brain correctly.

EARACHE 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.

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 cottonwrapped on a match stick or a clean broom twig.Mix one spoon of vinegar with one spoon of boiled water, andput a few drops of this into the ear 3 to 4 times a day.If there is fever as well, give COTRIMOXAZOLE orAMOXYCILLIN by mouth for five days.For relief from pain PARACETAMOL or ASPIRIN may begiven.

If 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(without needle) with warm water.

Children can be taught to checkthe ears of their siblings fromtime to time

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EARWAXEarwax is normal. To keep the ear clean, gently clean withcotton or the rolled end of a cloth.

If it is too much and one gets itching, loss of hearing or aringing sound in the ear, one can put 3 to five drops of cleanoil daily for three days to soak it and then ask someonetrained 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 thechemist’s shop, but usually these are not necessary.

Squirt warm water withsyringe (without needle) toclean inside of ears

2. 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 bymouth for seven to ten days.PARACETAMOL or ASPIRIN for relief from painmay be given.Carefully clean the pus out of the ear canal withsome cotton wrapped on a matchstick or a cleanbroom twig.DO NOT allow such children to swim. They may have a bath, but be careful that no water getsin 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 duringa cold.

Keep the child on a nutritious diet always.

DO NOT FEED a child with a bottle while she is lying on herback as it may flow back through her ear tube from her throatinto her middle ear.

3. Inner Ear InfectionsHalf-circle canals in the inner ears help us keep our body balance. If there are repeatedmiddle ear infections, the infection may travel to the inner ear and may also destroy thesemi-circular canals. This may cause problems in understanding the posture and lead toa sense of imbalance.

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Teach children not toblow their nose whenthey have a cold

DEAFNESSDeafness Is Caused By :

Either middle ear infections, earwax or due to a problem withthe nerves going from the ear to the brain.Some drugs like Aspirin and Streptomycin (for TB) in large dosesmay also cause deafness.Children may be born deaf if their mother suffered from someillness 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 AidsHearing aids or machines help toincrease the energy of the sound thatgoes till the inner ear. In people who arepartially deaf, they can help in hearingbetter.

If the eardrum has got punctured eitherby infection or accidentally while‘cleaning’ the ear, nowadays there areoperations these days to help repair theeardrum.

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. Drinkingcups of hot ginger tea can do wonders to a sore throat.

• If the voice has cracked, breathe some hot vapour as discussedearlier – the more times a day we can take, the better for us!.

• A type of bacteria – that causes sore throat can also harm theheart 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 throatagain and again or they have already got the heart disease, it makesbetter sense to give them a monthly

injection of Penicillin!

Gargle with warmwater

Note: If a government ENTspecialist or District Civil Sur-geon certifies that a person ishard of hearing, a person canget an electrical hearing aid freeof cost from the governmentthrough the district social wel-fare department.

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Know the AnswersDiseases of the Breathing System

1. Say whether this is right or wrong:a. Common cold can be cured with antibiotics.

b. Vapour inhalation is the cheapest and best waythat 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.