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Exploring the guideline for Homoeopathic management of Pneumonia in Children

Exploring the guideline for Homoeopathic management of Pneumonia in Children

Dr. Bipin Jain MD (Hom)

*Consultant dept of Pulmonology and Padiatrics , Prof and HOD dept of Materia Medica, Academic director, PHD and PG Guide Dr. M. L. Dhawale Memorial Homoeopathic institute and Rural Homoeopathic Hospital palghar

 

Pneumonia has consistently been estimated as the leading single cause of childhood mortality worldwide. More than half of the total numbers of pneumonia are among children under five occur in South Asia and sub-Saharan Africa.Homoeopathy has got significant role in the management of pneumonia. The references to the literature show different approaches to management of pneumonia by Nash, Borland, Pulford. They have clearly put down guidelines for the management of pneumonia based on their experience

 

Introduction-

Pneumonia is common, acute, lower respiratory and90% of deaths in respiratory illnesses are due to pneumonia & its complications. Over 2 million children under five die from pneumonia each year, accounting for nearly one in five child deaths globally. An estimated more than 150 million episodes of pneumonia occur every year among children under five in developing countries, accounting for more than 95% of all new cases worldwide

Definition – Pneumonia is an inflammation of the parenchyma of the lung.

Classification- Classified according to either by the specific etiologic agent or, if no pathogen can be isolated, by the clinical setting in which infection occurs.

  • Community-Acquired Acute Pneumonias

 

Mostly bacterial in origin. S. pneumoniae (Pneumococcus) is the most common cause &commonly the infection follows a viral upper respiratory tract infection.

  • Community-Acquired Atypical Pneumonias

 

The term “atypical” denotes the moderate amounts of sputum, absence of physical findings of consolidation, only moderate elevation of white cell count and lack of alveolar exudates.Mycoplasma infections are particularly common among children and young adults. Other etiologic agents are viruses, including influenza types A and B, the respiratory syncytial viruses, adenovirus, rhinoviruses, rubella, and varicella viruses; Chlamydia pneumoniae and Coxiellaburnetti (Q fever). Nearly all of these agents cause a primarily upper respiratory tract infection.

Anatomical Classification –

  • Bronchopneumonia– patchy distributionof inflammation, involves more than one lobe. This pattern results from an initial infection of the bronchi and bronchioles with extension into the adjacent alveoli.
  • Lobar pneumonia- the contiguous airspaces of part or all of a lobe are homogeneously filled with an exudate that can be visualized on radiographs as a lobar or segmental consolidation.

Etiology-

  1. Viral – Respiratory syncytial virus, Parainfluenza, Influenza, Adenovirus.
  2. Bacterial – Streptococcus Pneumoniae, klebsiella, E.coli, Staphylococcus Aureus, Group A& B Streptococci.                                                            c) Mycotic or Fungal infections – Moniliasis or thrush, Aspergillosis, Actinomycosis
  3. Atypical organisms – Chlamydia spp. & Mycoplasma.
  4. Hypostatic pneumonia
  5. Aspiration of amniotic fluid, food, foreign bodies, and lipoid substances.

Transmission-spread via air-borne droplets from a cough or sneeze &may spread through blood, especially during and shortly after birth.

Pathology-Despite the multitude of defence mechanisms, Viral pneumonia usually results from spread of infection along the airways, accompanied by direct injury of the respiratory epithelium, resulting in airway obstruction from swelling, abnormal secretions, and cellular debris. Viral infection of the respiratory tract can also predispose to secondary bacterial infection by disturbing normal host defence mechanisms, altering secretions, and modifying the bacterial flora.

Clinical features-

  • Often preceded by several days of symptoms of an upper respiratory tract infection, typically rhinitis & cough.
  • High grade fever in bacterial than viral pneumonia with Tachypnea
  • Increased work of breathing accompanied by intercostal, subcostal & suprasternal retractions, nasal flaring & use of accessory muscles
  • Bacterial pneumonia in older children typically begins suddenly with shaking chill followed by high fever, cough & chest pain accompanied by drowsiness with intermittent periods of restlessness; rapid respirations; a dry- hacking, unproductive cough; anxiety and occasionally delirium.

ComplicationsAbscess formation, Empyema, Organization of the intra-alveolar exudate may convert areas of the lung into solid fibrous tissue and Bacteraemic dissemination may lead to Meningitis, Arthritis or Infective Endocarditis.

 

Homoeopathic Review–Different Approaches towards Pneumonia

In Borland’s Pneumonia, Dr. Douglas M. Borland (1939) mentioned about the implication of homoeopathic therapeutics in cases of Pneumonia. He mentioned that homeopathic prescribing not only covers the acute pathological picture but also the reaction of the individual patient to that disease.

  • By prescribing low potencies you would relieve the patient’s distress, you would diminish the severity of the attack and you would avoid complications such as a developing pleural effusion and possibly empyema but by lysis the disease will run its normal period of seven to ten days. By using the lower potencies your matching of the drug symptoms with the symptoms of the patient does not require to be quite so accurate.
  • The second method of treating these acute conditions is by the administration of higher potencies – something above a thirty. You will find that by the administration of these higher potencies you abort the disease. The duration of the illness is very much shortened and Instead of getting the crisis from the seventh to tenth day you get it from twelve to forty-eight hours after starting treatment, irrespective of the day of disease. While using higher potencies matching of the drug symptoms with the symptoms of the patient should be accurate.
  • As far as repetition is concerned, where you are using low potencies, you have to keep up your drug administration right throughout the course of the disease. You will probably find that you have to give more than one drug; your first drug modifies the picture and you then get indications for a second prescription, and possibly a third, before the crisis takes place. Where you are using the higher potencies, it is advisable to continue the administration of the selected drug until the temperature has reached normal and has remained normal for at least six hours.
  • As regards the frequency of administration of the drug, in the average case, where you are using a low potency it is quite sufficient to give the drug about once in four hours. As far as the high potencies are concerned, it is wiser to give the drug every two hours, the reason being that you want a number of stimuli in a comparatively short period of time in order to obtain the crisis within twelve to twenty-four hours.

According to Dr.Nash, (Leaders in respiratory organs- 1909) any remedy might be indicated in any stage of complaint, and if so they must not be ignored. SimiliaSimilibus is the guide, no matter in what form or stage of this or any other disease.Under homoeopathic treatment the temperature will take care of itself as the patient comes under the influence of the indicated remedy. And it is so with every other so called disease.

Dr.Pulford in Homoeopathic leaders in PNEUMONIA (1940) mentioned the similimum will cut short any disease at any time and will act at once and rarely needs repetition. If it does need repetition it is not the similimum. The farther away you are from the similimum, the oftener you will have to repeat. Whenever a disease must run its, or a given, course it is a sign that you have at no time had the similimum and that the patient would have been fully as well off, if not better, had he had no medical interference whatever.

Considering all the above Leading directions given by different leaders in pneumonia, we thought of exploring the guidelines for treatment of pneumonia in children

  1. Data obtained from- a) clinical interview and observation b) General examination c) Systemic examination.
  2. Studied the clinical presentation of each case in terms of Location, Sensation, Modalities and Concomitants with consideration of the past history, family history and personal history of the patient for understanding of the background of case.
  3. Classification and evaluation of symptoms was done. After studying the individualizing characteristics of patient, both at mental as well as physical level, with observations similimum was selected according to the stage of pneumonia and involved location of lung.
  4. Then Studied and applied the posology based on susceptibility of the case

CASE-1

 Preliminary data

Name-Mast ACM, Age-8 Months, Sex-Male

Address- Bhopoli, DOA-22/3/12, DOD-24/3/12

CHIEF COMPLAINT(S):

No Location Sensation &Pathology Modalities

A.F, <, >

Concomitant
1. RS Since 4 days

Nose

On 1st day

2nd day

3rd day

 

Chest

Since today morning

Sudden

One episode

Coryza

Watery, profuse 2+

Cough 2+

In short bouts

Cough and Coryza

Rattling1+

Breathlessness1+

With fever

Post tussive vomiting containing sticky, white scanty vomitus

 

 

 

 

 

 

 

 

 

 

 

 

Crankiness2+,>carried outside in open air 2+

Moaning during fever2+,

Thirst increased for small quantity at short interval 2+

PAST HISTORY & FAMILY HISTORY – No any specific

PHYSICAL EXAMINATION-TEMP-101 F (A),PULSE -140/min, RR – 56/min, PALLOR +, WEIGHT-6 kgs,SPo2 without o2 – 98%

SYSTEMIC EXAMINATION-RS-Rt sided crepts. CVS – S1S2 + PA/CNS- NAD

INVESTIGATIONS – 22/3/12 CBC- Hb-8.50 WBC 7.600 N56 L40 E02 M02 B0

CRP Positive, Chest X-ray- Haziness right lower lobe

CLINICAL DIAGNOSIS – Right Lobar  Pneumonia,  Stage  of disease – Stage of consolidation

TOTALITY –

  • Crankiness 2+ >open air 2+
  • Moaning fever during 2+
  • Thirst increased for small quantity at short interval 2+
  • Coryza watery, profuse 2+
  • Cough in short bouts

Susceptibility: moderate-few characteristics, reversible pathology

FINAL REMEDY –   Pulsatilla, Potency-200, Repetitions- frequent, 4hrly

FOLLOW UP SUMMARY –

On admission important observations were moaning during fever & whenever child was taken outside the ward his irritability was better & rattling was not much, thermally-Hot& considering the above totality, differentiation was done between ant tart & pulsatilla. The slow onset, gradual progress, better in open air and low grade crankiness with absent of rattling and drowsiness differentiated antimony tart.

After the 1st dose highest temperature 100.4 subsided by its own in 3hrs. Moaning was better 30%, RR improved from 56 to 36 & no fever in 3days of admission. 10 doses given 4hrly in 2days & patient got discharged in 3days with on discharge 6hrs repetition for 2days.The sensitivity at mind level &susceptibility was moderate so 200 was prescribed.

CASE 2

Preliminary data:

Name-Mast SAP, Age-4 mns, Sex –Male, Address-Vikramgad , DOA-31/8/12,DOD- 5/9/12

CHIEF COMPLAINT(S):

No. Location

 

Sensation&Pathology Modalities

A.F, <, >

Concomitant
1. RS Since 4 days

1st day-Nose

 

2nd day-chest

3rd day

Since 8 pm

 

Coryza

Watery profuse2+

Cough dry2+

Breathlessness2+

& fever

 

 

 

>upright position 2+

<lying down 2+

Sleep disturbed

-Appetite diminished2+

Sleep with half eyes closed2+

PAST HISTORY – Hyperbilirubinemia FAMILY HISTORY – No any specific

PHYSICAL EXAMINATION

TEMP – 99.4 F(A), PULSE –154/min, RR –76/min, PALLOR+, WEIGHT – 6.240 kg, SPo2 without o2 – 89%, SPO2 with O2 – 95%

SYSTEMIC EXAMINATION– RS – Bilateral Crepts +, CVS – S1 S2 +, PA /CNS – NAD

INVESTIGATIONS – 3/9/12- Chest X-ray-Right sided Haziness below hilar zone

CBC- Hb-9.2, WBC-12, 800, N-70, L-25, E-03, M-02, B-0, CRP-positive

CLINICAL DIAGNOSIS – Right lobar Pneumonia-Stage of early consolidation

TOTALITY –Thermals- hot & Right sided pneumonia

  • Sleep with half eye closed2+
  • Dry cough < lying down 2+
  • Dry cough > upright poition2+
  • Flaring of alaenasi 2+
  • Right sided affection
  • Susceptibility: moderate-few characteristics, reversible pathology

 

FINAL REMEDY –Lycopodium- 200, 4hrly

While observing this child in the IPD, whenever the child was kept uncovered, he was comfortable; there was an obvious movement of alae nasi than any other accessory muscle of respiration. As soon as the child was kept on the bed in lying down, cough bouts used to increase & breathing used to become distressful. Finally child slept in upright position in hand of parents with half eyes open. Considering all these important observations & totality, the lyco was the most suitable remedy.

Lyco 200 was started 4hrly with O2- after the 1st dose temp spike increased till 101.2 F, RR- 76/min & started subsiding by itself in 3hrs. 2nd day the spike was 99.4F,RR- 44 improved & baby started managing the SPo2 without O2 till 91%(before -89%) with hunger cry,  on 3rd day, activity was >+2, baby started playing.O2 removed, on 4th day improvement continued & finally baby was discharged on 5th day morning with Lyco 6hrly for 2days.

CASE-3

Preliminary data:

Name   Mast AAY, Age-6 Months, Sex -Male

Address-Kolgaon, DOA -14/10/12, DOD-17/1012

CHIEF COMPLAINT(S):

No Location

 

Sensation&

Pathology

Modalities

A.F, <, >

Concomitant
1. Respiratory system

O- Gradual

D- Since 1 week

P- Insidious

Nose

1st 3 days

Since 4 days

(4th day of illness)

1 episode

 

5th day

Chest

6th day

 

 

Since night

7th day

Coryza -thin watery2

Cough in paroxysm

Wet cough2

Post tussive vomiting

Fever high grade

Rattling2+

Cough2+

Fever and cough increased with excessive crying 2+

Not accepting feed

Breathlessness 2+

 

 

 

 

 

 

 

<lying down2

<crying during2

< night2

 

 

 

 

 

 

 

 

 

 

 

Thirst decreased2+

Appetite diminished2+

 

 

 

 

Irritability during fever 2+

PAST HISTORY &FAMILY HISTORY –No any specific

PHYSICAL EXAMINATION

TEMP – 98.4 F (A) PULSE – 160/minRR – 78/min

PALLOR -+WEIGHT – 8.5 kgSPo2 without o2 – 94%

SYSTEMIC EXAMINATION

RS – Bilateral basal crepts+, SCR+,ICR+,  CVS/PA/ CNS – NAD

INVESTIGATIONS –15/10/12

CBC-Hb -9.3 mg/dl,WBC -12,400/cmm,N-30,L-65,E-03,M-2,B-0

CRP-Negative, Chest X-ray-Consolidated patch over right upper zone

CLINICAL DIAGNOSIS– Right sided Pneumonia, STAGE OF DISEASE-Stage of Consolidation

TOTALITY

  • Irritability during fever 2+
  • Thirst decreased 2+
  • Cough < night 2+
  • Cough < lying down 2+
  • Cough < crying during 2+
  • Rattling in chest 2+

Susceptibility: Moderate-few characteristics but high sensitivity, reversible pathology but very high RR

 

FINAL REMEDY –  Antim. Tart, POTENCY- 1M, REPETITIONS- Frequent (2 hourly)

FOLLOW UP SUMMARY-

Considering the acute clinical presentation Antim Tart.1M was indicated, repeated after every 2 hrs. On the first day improvement is observed in RR (78 to 55), irritability, appetite and thirst and patient was afebrile within 24 hours. On the 3rd day Ant tart administered 4hrly for 2days then discharged on Antim.Tart. 1M- 4 hourly for next 2 days.

Discussion-

In the management commonly observed that generals start improving first like activity & food habit though child is febrile. There is significant improvement in the subjective and objective criteria and thus the improvement in susceptibility. It is also observed that it helped in aborting the disease and cut down on the duration of suffering.

Guidelines:

1) Successful treatment needs accurate history taking and defining the stage and state of disease with the help of evolution, physical examination and investigation.

2) One needs to understand the characteristics in the case by doing analysis and evaluation of the symptoms and matching it with Materia medica through the help of repertorial references. One will need to differentiate the remedy based on characteristics, evolution of the disease, and location of the pneumonia.

3) One needs to understand the susceptibility of the case which will guide the selection of potency and the repetition

4) Clearly defined follow up criteria guides the physician in the treatment of the case as general starts improving first and particulars later.

Conclusions-

  • Homoeopathic treatment is absolutely effective in aborting the stages of pneumonia
  • It significantly diminishing the distress and avoids the complications
  • Improvement at generals is seen in few hrs after the similimum as well as child becomes active & comfortable in low grade fever also.
  • Fever tapers down in 1-2days in uncomplicated cases.
  • Improvement is seen at both subjective & objective level
  • Frequent repetitions of remedy helps to stimulate the susceptibility in acute stress of pneumonia
  • It also substantiate the living picture of pneumonias as described in therapeutic part of the Borland’s Pneumonias

References-

  1. http://www.who.int/mediacentre/factsheets/fs331/en/index.html
  2. http://kidshealth.schn.health.nsw.gov.au/fact-sheets/pneumonia
  3. http://www.worldvision.org/content.nsf/about/press-development-pneumonia-facts
  4. Beherman Richards, Kliegman Robert M, Jenson B Hal(2010); Nelson textbook of Paediatrics; edition 18th; chapter Respiratory disorders; New Delhi.; Elsevier a division of Reed Elsevier India Pvt. Ltd
  5. Borland Douglas M. Borland’s pneumonia; (Reprint 2003, 2008); B. Jain publishers Pvt. Ltd. New Delhi.
  6. Pulford- Homoeopathic leaders in PNEUMONIA (1940)
  7. Harsh Mohan (5th Edition 2005); Textbook of Pathology; Respiratory System, Jaypee Brothers Medical Publishers (P)LTD, New Delhi.
  8. Kumar Abbas Fausto Mitchell; Robins basic pathology (8th edition); A Harcourt Publishers International Company.
  9. Nash E.B; Leaders in Respiratory Organ; Indian books and Periodicals publishers, New Delhi.

 

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