The division of chest medicine cares people's respiratory system. Such symptoms as cough, phlegm, bloody sputum, fever, shortness of breath, chest distress, wheezing, cyanosis and labored respiration all fall into the category of chest medicine.
Diseases concerning chest medicine include upper respiratory tract infection (colds), foreign body airway obstruction, bronchitis, asthma, chronic obstructive pulmonary diseases (COPD) (emphysema and chronic bronchitis), bronchiectasis, pneumonia, tuberculosis (TB), tumors of lung, lung cancer, respiratory failure, etc.
Indications concerning chest medicine include cough, bloody sputum and chest distress, asthma, pneumonia, bronchitis, TB, tumors of lung, removal of foreign object from respiratory tract and bronchiectasis. Consultations on other pulmonary diseases and cessation of smoking are also provided.
Acute respiratory failure also falls into the category of chest medicine. The chest medicine and critical care unit collaborates with the other two medical centers of CMUH: Hyperbaric Oxygen Therapy Center and Sleep Center.
Respiratory Care Center (RCC) is established for patients who need to rely on mechanical ventilators for a period of time.
In a session of hyperbaric oxygen therapy a patient is placed in a chamber where the air pressure is increased to above normal air pressure. Pure oxygen inhaled promotes wound healing. Hyperbaric oxygen therapy is used to treat carbon monoxide poisoning and fatal gas embolism as well.
Sleep Center is a convergence of interdisciplinary and multi-division examine center, where problems of troubled sleeping are treated and continuous health care is provided to secure quality sleep.
- Patients of high risks: the elderly (94% of those who died of flu are individuals aged over 60) and those who suffer from chronic respiratory diseases (asthma included), chronic heart diseases, chronic renal failure, diabetes, and other metabolic diseases and immunosuppression.
- People prone to contract or spread flu: health care personnel, family members of patients of high risks, teachers, and people staying in a nursing home or a rehabilitation center.
- Anyone who wants to avoid contracting flu: children, students (especially boarding school students), people who lead a group lifestyle, and individuals who frequently travel for business or leisure purpose.
The current focus of asthma treatment is “asthma control” rather than “cure”. Therefore, asthmatic patients’ cooperation with their doctors by properly taking anti-inflammatory drugs can largely reduce the risk of asthma attack. The risk of dying of severe asthmatic episode will also decrease.
Since 1998 Health Promotion Administration, Ministry of Health and Welfare has initiated “Asthma Education Program” to design and establish a resourceful network that trains professional consulting personnel and provides information concerning asthmatic health care. The goal is to promote the self-care knowledge of asthma. At the beginning of the program CMUH incorporated group health education into it, aiming to offer as much information as possible and to encourage favorable cooperation from our patients so that the condition can be managed well.
Some artificial chemical compounds pose a threat to human body. There are now over 50 thousand known compounds; over a thousand newly synthesized compounds add to the number per year. Among these many chemical substances only 7,000 have been studied in detail, and of the studied 1,500 have been proved to be carcinogenic through animal tests. Carcinogenic substances that inflict on respiratory system include asbestos, chrome nickel, coal tar and radon the chemical element. Asbestos is used widely for insolation material and heat-proof products. Chrome nickel can be found in refineries and electroplating factories, whereas coal tar is used in boiler industry. All three cause cancer of respiratory tract.
Every year Taiwan witnesses 15,000 to 16,000 cases of TB, 1% of which is multidrug-resistant tuberculosis (MDR-TB). The growing MDR-TB epidemic is mainly due to patients’ inadequate adherence to the doctor’s advised treatment, a behavior results in drug-resistant mycobacterium tuberculosis. The number of MDR-TB cases in Taiwan has reached 600 and 164 more in 2010.
We align with the procedure recommended by WHO to adopt the result of a sputum culture test as a critical standard to treat MDR-TB patients: after taking medication, the patients must show two times of negative result in a row on the test before they can enter a 1.5-year course of medication to end the whole treatment regimen, which can be completed in 2 to 3 years.
According to WHO's latest research report on MDR-TB, 440 thousand people are suffering from MDR-TB, approximately accounting for 3.6% of the TB cases worldwide. Half of the global TB cases occur in China and India, where the mortality rate shows as high as 50%. It will be reckoned as alarming if reported MDR-TB cases account for over 5% of the additional TB cases in one region: China, India and Eastern Europe all claim a figure over 10%.
Pneumothorax occurs when air is stranded in pleural cavity, the space between your lung and chest wall. Spontaneous pneumothorax occurs when air leaks from lungs; the incidence rate is around 9 out of 100 thousand: the male-to-female sex ratio is approximately 6:1. 85% of the patients diagnosed with the disease are under 40 years of age.
Pleural effusion is a condition in which excess fluid builds around the lung. Symptoms are dyspnea, chest pain, etc. The disease can be categorized as transudative and exudative pleural effusion.
On the diagnostic front, we provide biochemical examination of pleural fluid, cytologic examination, bacterial culture test, pleural biopsy and thoracoscopy, while on the other front of treatment:
- Malignant pleural fluid: supportive treatment such as pleurodesis currently is the main strategy to avoid excess pleural fluid.
- Empyema and parapneumonic effusion: Clinically, the difference between empyema and parapneumonic effusion must be recognized because the latter can be cured by injection of antibiotics alone, while the former necessitates insertion of a chest drain.
- Tuberculous pleurisy: Generally anti-tuberculosis drugs are used before draining, but long-term placement of chest tube should be avoided to prevent formation of a fistula.
Use Mechanical Ventilation to Treat Various Acute and Chronic Respiratory Failure
The conventional strategy to address acute respiratory failure is to perform endotracheal intubation and tether the patient to a positive pressure ventilator for saving his life. The drawback of endotracheal intubation however lies in the danger of multiple complications. To avoid triggering any complications, we use noninvasive positive pressure ventilators to address acute respiratory failure, and satisfying treatment outcomes are witnessed.
A bronchoscope is a flexible endoscope. Your doctor will thread the instrument through your nose, mouth, your endotracheal tube or tracheostomy tube to reach your airways to implement airway washing and collect lung tissue samples for biopsy to see if a further examination is necessary. Preparation for the tests and procedures in the following paragraphs includes local anesthesia and procedural sedation. A bronchoscopy can be performed without an operating room environment.
Endobronchial Ultrasound (EBUS) is a combination of bronchoscopy and ultrasound. A bronchoscope is used to pass a small ultrasound probe into the trachea or the bronchus for precise diagnosis of lung lesions. EBUS-TBNA assists physicians in evaluating the peribronchial lymph nodes, the lesion of mediastinal tumor, tumor-invaded bronchial wall, and consolidated lesion in the lungs. If swollen mediastinal lymph nodes are observed, a biopsy needle is to be passed through a bronchoscope to collect samples. Compared with the conventional mediastinoscopy with biopsy, endoscopic thoracotomy and open thoracotomy, EBUS serves as a more comfortable choice.
A small balloon particularly designed to pass a bronchoscope treats tumor-induced airway narrowing by inflating the balloon with water.
Through a bronchoscope a powered hyperthermic probe is passed to the airway to remove tumors. Local hyperthermia causes irreversible damage to tissue proteins and blood coagulation, which helps treat patients who have hemorrhage problem due to tumor invasion.
Titanium-nickel alloy endotracheal stents are flexible at room temperature and become rigid, tubular in structure when implanted in human body as its temperature rises to body temperature. By leveraging this material property, the trachea obstructed by tumor can be distended. And no distinct rejection has been found thanks to the special alloy material.
Argon plasma results from ionized argon gas. During the procedure high frequency current is conducted to tracheobronchial lesions. Without directly contacting the lesion tissue APC can treat a large area for blood coagulation or thermal ablation. Tissue attachment hardly happens during the process. Damage to the tissue is controlled to prevent penetration because the affected depth is only 3mm. The current automatically changes direction; regions that are difficult to reach can thus be treated. APC produces less smoke during treatment, leaving clearer view for the physician. Moreover, mild carbonation and desiccation of the treated tissue speed up wound healing.
In recent years cryotherapy has been applied to airway treatment, including foreign object removal and tissue sampling. Using cryotherapy to remove object takes much less time than conventional methods, making patients more comfortable. Additionally, through a bronchoscope or a pleuroscope, the tissue obtained by the probe tip, which is larger and more complete than by the average tissue forceps, can facilitate the diagnosis of a certain condition.