Khanpur chest clinic

03/08/2025

“TB = ‘pneumonia’ that doesn’t get better” (and vice versa).

Among the public and some clinicians, there may be a simplified notion that TB is just a form of pneumonia. This leads to assumptions such as “if antibiotics didn’t cure the pneumonia, then it must be TB,” or conversely, that “starting TB treatment will cover any bad pneumonia.” In reality, TB is a distinct disease – while it does infect the lungs, its progression, treatment, and public health implications differ from ordinary bacterial pneumonia.

Thinking of TB as interchangeable with pneumonia can cause delays (someone might try multiple antibiotic courses for recurrent “pneumonia” before considering TB) and also stigma (patients may hide a TB diagnosis by calling it ‘just pneumonia’).

Clarity in communication is needed: persistent pneumonia symptoms should indeed trigger TB evaluation, but the two are not the same and require different tests and treatments.

03/08/2025

Very important point

Misuse of the Mantoux/IGRA tests:

As mentioned earlier, a frequent misconception is using a Tuberculin Skin Test (TST) or IGRA blood test to diagnose active TB. Many patients will report “I had a TB test and it was negative, so I can’t have TB” – not realizing that those tests only detect immune memory of TB, and in a high-burden country most adults will have positive TST/IGRA due to latent infection, which doesn’t confirm active disease.

Conversely, in some low-burden settings, doctors order IGRA tests on a patient with cough to decide if TB is likely; a negative IGRA might wrongly dissuade further TB workup even if the patient actually has active TB (IGRA can be false-negative in active TB, especially in immunosuppressed persons).

Guidelines explicitly state IGRAs and TST have no role in the routine diagnostic workup of active TB in adults, due to their inability to discriminate latent vs active TB and their limited sensitivity . They are useful for latent TB screening and sometimes as supportive evidence in pediatric or extrapulmonary cases (in combination with other criteria), but should not override microbiological diagnostics for active pulmonary TB.

26/07/2025

Oxygen therapy in Asthma

In acute asthma exacerbations, hypoxemia is common due to ventilation-perfusion mismatch, and supplemental oxygen should be given to maintain saturation (typically ≥92–94% in severe asthma) .

Fortunately, most young asthma patients are not chronic CO₂ retainers, so the risk of oxygen-induced hypercapnia is lower than in COPD. The primary pitfall in asthma is failing to recognize impending respiratory failure because oxygen saturations alone look “acceptable.”

A severely asthmatic patient may have near-normal SpO₂ on 100% O₂ while their work of breathing is extreme and CO₂ is building up due to exhaustion. Hypercapnia in status asthmaticus is a late and ominous sign, indicating fatigue and possible respiratory arrest . Thus, sole reliance on pulse oximetry can be misleading in a “crashing asthmatic.”

Clinicians must closely observe respiratory rate, use of accessory muscles, mental status, and measure ABGs early.

Another pitfall is delaying intubation in a failing asthmatic because the O₂ saturation is still decent; by the time SpO₂ falls, the patient may be in extremis.

Best practice is to provide high-flow oxygen to correct hypoxemia and concurrently assess ventilation (capnography or blood gases). Bronchodilators and steroids are the main therapy, but oxygen buys time. Also, be cautious during intubation of asthmatics – they are at risk for dynamic hyperinflation; allow permissive hypercapnia and avoid aggressive ventilation (which can cause barotrauma).

In summary, give oxygen freely in acute asthma to avoid hypoxia, but watch for the subtle signs of fatigue that signal the need for ventilatory support, even if O₂ saturation appears acceptable

23/07/2025

انہلیرز اور ڈرائی پاؤڈر انہلیرز (DPIs) کے بارے میں کچھ عام غلط توہمات !

غلط فہمی 1: انہیلرز صرف شدید دمہ کے مریضوں کے لیے ہیں جبکہ
در حقیقت انہیلرز مختلف نوعیت کے دمہ کے علاج کے لیے استعمال کیے جا سکتے ہیں۔ بلکہ یہ اکثر دمہ کے علاج کے لیے پہلی لائن تھراپی کے طور پر تجویز کیے جاتے ہیں۔

غلط فہمی 2: انہیلرز استعمال کرنا مشکل ہے جبکہ درحقیقت انہیلرز استعمال کرنا نسبتاً آسان ہے۔ مختلف قسم کے انہیلرز دستیاب ہیں، اور ڈاکٹر آپ کو یہ سکھانے میں مدد کر سکتا ہے کہ آپ کا مخصوص انہیلر کیسے استعمال کیا جائے۔

غلط فہمی 3: انہیلرز لت ( addiction ) لگانے والے ہیں جبکہ درحقیقت انہیلرز لت لگانے والے نہیں ہیں بلکہ دوائیوں کی ایک قسم ہیں جو سانس کی نالیوں کو کھولنے اور سانس لینے کو آسان بنانے کے لیے استعمال ہوتی ہیں۔

غلط فہمی 4: انہیلرز صرف دمہ کے شدید حملوں کے علاج کے لیے استعمال کیے جاتے ہیں جبکہ در حقیقت انہیلرز شدید حملوں کے علاج اور روک تھام دونوں کے لیے استعمال کیے جا سکتے ہیں۔ انہیں باقاعدگی سے لینے سے دمہ کو قابو میں رکھنے اور حملوں کو روکنے میں مدد مل سکتی ہے۔

غلط فہمی 5: انہیلرز بچوں کے لیے محفوظ نہیں ہیں جبکہ در حقیقت انہیلرز عام طور پر بچوں کے لیے محفوظ ہیں۔ تاہم، اپنے بچے کو انہیلر دینے سے پہلے اپنے ڈاکٹر سے بات کرنا ضروری ہے تاکہ یہ یقینی بنایا جا سکے کہ یہ آپ کے بچے کے لیے صحیح ہے اور اسے صحیح طریقے سے کیسے استعمال کرنا ہے۔

انہیلرز دمہ کے لیے ایک موثر علاج ہو سکتے ہیں، لیکن یہ ضروری ہے کہ آپ انہیں اپنے ڈاکٹر کی ہدایات کے مطابق استعمال کریں۔

16/07/2025

Molecular Testing for pleural Tuberculosis:

The development of Xpert MTB/RIF and Xpert Ultra (rapid cartridge-based PCR tests) has impacted pleural TB diagnosis. While pleural fluid itself has limited sensitivity on Xpert (~30-50%), performing Xpert on pleural tissue obtained via biopsy significantly improves detection . One prospective study found that Xpert Ultra on thoracoscopic pleural biopsy samples substantially increased TB diagnostic yield, even detecting some cases that histology missed .

These molecular assays also detect rifampicin resistance, giving a head start on identifying drug-resistant TB. Additionally, next-generation sequencing (NGS) techniques are being explored to detect mycobacterial DNA in pleural fluid or tissue. Another novel approach is measuring pleural fluid lipoarabinomannan (LAM), a TB antigen, though this is still investigational for pleural TB. Overall, molecular diagnostics are shortening the time to TB diagnosis and may become standard to pair with biopsy in high TB burden areas.
Dr Nasir Ali Rana
Pulmonologist
Khanpur chest clinic
Model town A khanpur katora District rahimyar khan

01/05/2025

10/04/2025

Most post-viral coughs resolve by 8 weeks after infection (hence the upper limit of subacute cough definition). Many improve sooner, within 3–4 weeks. However, in some cases, the cough can drag on even longer – at which point it effectively becomes a “chronic cough” that might prompt further evaluation.

A common scenario is a patient who had a viral bronchitis, has been coughing for 6 or 7 weeks, and is now in a gray zone: this could still be postinfectious, or the infection could have unmasked an underlying tendency (such as mild asthma that becomes apparent due to the inflammation).

Another timely example is post-COVID cough: A significant number of patients experience persistent cough for weeks or months after COVID-19 infection. The mechanisms there likely include residual inflammation, injury to sensory nerves, and possibly lung damage in severe cases. Fortunately, for most post-COVID cough patients with mild initial illness, the cough does abate over a few weeks with supportive care, though a minority have prolonged cough that needs management.
Dr nasir ali rana Pulmonologist
Khanpur chest clinic

03/02/2025

Fifty per cent of patients with symptomatic asthma are reported to have a neutrophil inflammatory phenotype with high sputum neutrophil counts ranging from 40% to 76% of sputum cells. Sputum neutrophilia has been associated with severe asthma, corticosteroid insensitivity, and chronic airflow obstruction

22/01/2025

Asthma Medications During Pregnancy

1. Short-Acting Beta-Agonists (SABA)

• Examples: Albuterol (salbutamol), levalbuterol.

• Use: Relieve acute symptoms (“rescue inhalers”).

• Safety: Well-tolerated; considered first-line for acute asthma symptoms during pregnancy.

• Evidence: No significant increase in congenital anomalies.

2. Inhaled Corticosteroids (ICS)

• Examples: Budesonide (preferred), fluticasone.

• Use: Maintenance therapy for persistent asthma.

• Safety: Budesonide has the most safety data and is the preferred ICS during pregnancy.

• Evidence: Studies show no significant increase in adverse pregnancy outcomes.

3. Long-Acting Beta-Agonists (LABA)

• Examples: Salmeterol, formoterol. • Use: Add-on therapy for moderate-to-severe asthma when symptoms are not controlled with ICS alone.

• Safety: Generally considered safe when used in combination with ICS.

• Evidence: No clear evidence of adverse pregnancy outcomes when used appropriately.

4. Combination ICS/LABA Inhalers

• Examples: Budesonide/formoterol, fluticasone/salmeterol.

• Use: For patients with moderate-to-severe asthma requiring both ICS and LABA.

• Safety: Effective and safe as part of a stepwise asthma management plan.

5. Leukotriene Receptor Antagonists (LTRA)

• Examples: Montelukast, zafirlukast.

• Use: Alternative or add-on therapy for asthma not well-controlled by ICS/LABA.

• Safety: Limited data in pregnancy; generally reserved for patients who were well-controlled on LTRA pre-pregnancy.

• Evidence: No conclusive evidence of harm, but not first-line due to limited data.

6. Oral Corticosteroids

• Examples: Prednisone, prednisolone.

• Use: For severe asthma exacerbations or when symptoms cannot be controlled with inhaled therapy.

• Safety: Short-term use for exacerbations is generally safe, but long-term use may increase risks of preterm birth, low birth weight, and gestational diabetes.

• Evidence: Should only be used when necessary, with benefits outweighing risks.

7. Theophylline

• Use: Rarely used due to side effects and need for monitoring.

• Safety: May be used in select cases if asthma cannot be controlled with other medications.

• Evidence: Safe in pregnancy with proper dosing, but less preferred due to narrow therapeutic index.

8. Biologic Therapies

• Examples: Omalizumab (anti-IgE), mepolizumab (anti-IL-5).

• Use: Severe allergic or eosinophilic asthma.

• Safety: Limited data, but studies suggest omalizumab may be safe when benefits outweigh risks.

• Evidence: Should only be considered under specialist guidance for severe asthma.
DR NASIR ALI RANA
PULMONOLOGIST

05/01/2025

Cases of this virus are increasing in China......travellers to China to be careful

28/12/2024

“Hemodialysis-induced asthma has been attributed to the bronchospasm caused by acetate in the dialysate. Replacement of acetate by bicarbonate in the dialysate has resulted in resolution of this unusual problem. ”

24/03/2024

World Tuberculosis (TB) Day, 24 March 2024, continues with the theme “Yes! We can end TB”. TB is still one of the world's deadliest diseases and recent years have seen a worrying increase in drug-resistant TB. World TB Day is an opportunity to renew commitment, inspire and take action to end TB.