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INTERVIEW
An Insight Into Tuberculosis
by WAJIHA JAWAID

sans borderDr. Faizullah A. K. Lokhandwala has been working as a senior chest specialist at the Ojha Institute of Chest Diseases for the past eight years. After completing his MBBS from Sindh Medical College, he completed his house job at the Jinnah Postgraduate Medical Centre in cardiovascular diseases. He is one of the few Pakistanis who have had the privilege to receive a fellowship at the American College of Chest Diseases. Recently MAG caught up with him to get an insight into chest diseases like tuberculosis. Excerpts:

Q: Why did you decide to pursue a career as a chest specialist?
A:
During my residency at JPMC I came to know that cardiology and chest diseases are quite interrelated. I was also in the company of renowned professors such as Prof. Aamir Shafqat, Prof. S. M. Rao, Prof. Hameed, Prof. Mazur ul Haq and Prof. Illyas who further influenced me to specialise in chest diseases.

Please explain to us the nature of your job?
I treat patients with chest diseases especially those with tuberculosis. But I am also a general physician and it is very important for me to rightly diagnose illness my patients complain of, so if someone has a heart problem I can't ignore it. I have to prescribe medication to him keeping his complete medical history in mind so that it doesn't cause any side effects and complications related to any other disease.

What are the most common chest diseases in Pakistan?
Tuberculosis is the most common of all chest diseases in Pakistan and it is on the rise. Bronchial asthma, chronic obstructive pulmonary disease (COPD), occupational lung disease, lung cancer caused by addiction to chewing tobacco, betel nuts, gutka, and supari are some other commonly found chest diseases.

How is asthma different from tuberculosis? What are the signs, symptoms and treatment of bronchial asthma?
Bronchial asthma is entirely different from tuberculosis. It can manifest at any age to a person of any gender. The symptoms of asthma are coughing – this often becomes worse at night – breathlessness and wheezing, which are called musical sounds. Possible asthma triggers include pollen, dust, smoke or other allergens. Carpets also have microscopic mites, which are not visible to the naked eye but can cause asthma. These triggers can cause reactions in the small cavities of lungs. The medical term for this is bronchoconstriction. People afflicted with this disease experience inflammation of their respiratory pipes which blocks airflow and causes difficulty in breathing. I usually give two types of medicines to asthmatics, to control inflammation and to cure narrow respiratory airways.

What are the common irritants that can cause asthmatics having difficulty in breathing?
There are some particles and odours that naturally cause an asthmatic patient to have difficulty in breathing. Common irritants are perfumes, paints, varnishes, cooking fumes, household cleaners, air pollutants, talcum powder, chemicals in the air, changes in weather conditions and chemical exposure.

What are the signs and symptoms of TB?
Pulmonary tuberculosis (TB) is caused by the bacteria mycobacterium tuberculosis. A person can get TB by breathing in air droplets from a cough or sneeze of an infected person. The disease spreads quickly in slum areas where people are malnourished and have weak immune systems. The chances of TB are also high in drug addicts. TB can manifest in any part of the body but the root of infection is usually one's nose, mouth, skin and blood. It can be of the brain, skin, throat, genital organs or private parts of the body. The mycobacterium after entering into blood starts multiplying and if the person has a weak immune system then he is more likely to contract TB. The signs and symptoms include light fever throughout the day, chills, sweating, significant weight loss and cough with sputum. In severe cases the sputum also contains blood.

Is TB easily transmitted to others?
It has been found that when a TB patient coughs, the disease is transmitted to around 10 to 15 persons at the same time. Even doctors are not safe as they are in constant contact with them. TB patients should take necessary precautions to curb the spread of this disease; they should be extra cautious and always keep a piece of cloth on their face when coughing which should then be immediately disposed off.

As children, we are vaccinated against TB. Does this not mean that we are protected against the disease?
Bacille Calmette Guerin (BCG) is the current vaccine for tuberculosis. It is most effective in protecting children from TB. BCG has to be given to infants within 2 or 3 days of their birth. An expanded program of immunisation of TB has been initiated in Pakistan, under which children living in slum areas are vaccinated but it is very important to know that BCG only provides immunity for only 2 or 3 years, later the immune system of the child's body becomes so strong that it provides resistance to the disease.

What is the best treatment available for tuberculosis?
There are different stages of TB. Patients who are diagnosed with TB for the first time are under Category-I. The treatment recommended for them continues for eight months. In the initial stage the sputum of the patient is tested for three consecutive days. Later an X-ray of the lungs provides complete information about how much loss mycobacterium has already caused to the lungs. After the complete diagnosis, the patient is given four medicines, which should be consumed before breakfast. After two months the sputum is again tested and the patient is required to take only three medicines which continue for another six months. With proper medication, good healthy diet and a better quality of life, patients can easily recover from TB.
Next is Category-II; patients, who have re-contracted TB or have abandoned the treatment before complete recovery, fall under it. I suggest the second line of medication for them which includes a powerful vaccine other than the four regular medicines. The multi drug resistant, commonly known as MDR is another category in which the patient becomes resistant to the four medicines and for him a very expensive treatment has to be suggested that has to continue for 16 to 24 months and can cost around 2 to 2.5 lakh per patient. Another complex stage is extensively drug resistant and there is no medicine for its cure.

Could you explain the concept of sanatoriums related to the treatment of TB?
TB is a very ancient disease; it has even been founded in the spinal cord of an Egyptian mummy. The concept of sanatoriums is also very old – earlier, TB patients used to be kept in huts as health professionals believed that clean, cold mountain air was the best treatment for lung diseases. Now with modern medication and exceptional diagnostic tests it has become easier to provide treatment to TB patients. Now we only keep serious TB patients in sanatoriums but for others, we recommend them to stay at home and continue with their medication.

Is a change in diet needed to avoid chest diseases?
Everyone should strive to have a good healthy diet. A balanced diet and a good quality life play an important role in the cure of patients.

What are the main challenges related to your profession?
The most challenging part is to deal with patients who are addicted to drugs. Nowadays chest diseases are spreading in society as people are willingly adopting bad habits like sheesha smoking.

Please share with us the proudest moment of your professional career?
I have several achievements to my credit; I have presented research papers on chest diseases in international conferences in Dubai and Singapore. But the proudest moment for me was one when I was awarded a fellowship at the American Institute of Chest Diseases. It was really a big achievement as I was one of the few selected Pakistani who had the privilege to earn international fame for their country.


 
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