1. 2
THE BREATHING SYSTEM
We hear of the first breath and
the last breath….
Breathing is something, which
we do the moment we are
born till the moment we die.
So, what is this impor-
tant thing
called
breathing?
How does it happen?
What in our body helps us
to breathe?
What are the illnesses that
can affect our breathing?
In this lesson, we will learn
about organs that help us to

2. 2-1
Our Breathing System
nose
throat
voice box
wind pipe
bronchus
lungs
diaphragm
Organs in our body that help in Breathing
Starting from the nose, the breathing system has organs like
the throat, voice box, windpipe and the entire lungs with
the small pipes to carry air within them. The sinuses are air
pockets in the skull bones and also may be seen as part of
the system. Let us see their roles one by one.

3. 2-2
NOSE
What is the nose made up of?
The upper part of the nose is partially made of bone while the lower part is
made 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 produce
sticky fluid, but much of such fluid also comes from the air sinuses in the
bones – read below – around the nose that open into the cavity of the nose.
What does the Nose Do? Why does our Nose leak?
1. Our nose cleans the air we breathe in. It nose When the air is too cold or too hot,
stands guard to see that the air that enters our body is the nose tries to bring out some sticky
dust free. Smal hair at the entrance of the nose filters fluid. The air that we breathe will have
to pass through this fluid and hence
the dust from the air before allowing it to pass inside.
its temperature will come closer to the
body temperature. Too much of fluid
2. Trapping Germs: The sticky fluid traps germs so may come out to make our nose leak
that it does not enter our lungs. or we sniffle.
3. . It warms the air: Apart from cleaning the air, Also, when we have a cold lots of
the nose also makes the temperature of the air accept- sticky fluid is produced. This helps
able to the body before it allows this air to reach our wash off the germs that might trouble
lungs. us if they got inside our lungs.
4. Our nose helps us smell: The nose also helps us The sneeze reflex, an automatic reac-
tion by which the nose throws out with
to smell, a function that is more useful to the digestive
great force what irritated it, also keeps
system, because it starts the regular digestive wave in
harm away from the lungs.
that system.
You Cannot Cure A Cold !
A cold cannot be cured! There is no medicine made till date that
can cure a common cold. Since it is due to an attack of a tiny
germ – a virus – we should remember that the nose is trying to
throw it out by bringing out a lot of sticky fluid or mucous.
When we have a cold, instead of taking some tablets ot medicine
immediately, we should take plenty of hot fluids and keep a cloth
handy to wipe our nose. Some ‘cold medicines’ may bring relief
from a bit of fever and headache, but are also likely to delay the
cure !

4. 2-3
SINUSES
Why 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, they sinus
also make sticky fluid to trap germs & dust. They give a
hollowness to our voice when we talk. During a cold, these
sinuses fill up with a lot of sticky fluid. and changes our voice.
What to do in Sinus Infection?
Heaviness in the head, pain over the cheeks The biggest sinuses
and a stuffy nose following a cold tell us are those inside our
about the infection of the sinuses. To feel cheeks. The
better, heat some water in a pan and breathe openings of these
in its vaopur. sinuses are very
high and it is
Then, bend your head forward, tilt it to one difficult for them to
side and blow firmly to empty the sinus. Do be emptied easily.
the same on the other side. So, we get a feeling
of heaviness around
Take hot drinks like tea, coffee or soups. Inhaling vapour is the best our nose and below
and cheapest remedy for most illnesses of the breathing system. our eyes when we
have a cold.
THROAT The Throat
The throat starts from the end of the mouth and the
nose till where the wind pipe and the food pipe begins.
It also includes the voice box (the thing we can see
from outside in our neck).
The throat has a lining inside that is open to germs from
the food and drinks we take, or from the air we breathe.
For example, if we share food with a person who has a
sore 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 that
room is also likely to get the germs.
tonsils
Infection of the throat leads to pain in the throat and
dry cough. If the germs have infected the part joining throat
the food pipe, we are likely to find difficulty in
swallowing. If it has infected the front part (the part Ask your neighbour to open her
joining the windpipe) or the voice box that has vocal mouth and ask her to say
cords to bring out our typical voice – our voice is likely “aaaaaa………” . You can see most of
to change and we may also end up being voiceless. the throat including the tonsils

5. 2-4
VOICE BOX
The voice box or the larynx (la-rinks) is that portion
of the front of our neck that juts out, and can be seen
more prominently in men. The windpipe begins from
just below this.
The voice box has a fold of lining on either side that
can stretch or relax. These folds – also called vocal
cords by either stretching or relaxing – can make the
difference in our voice . The shape of the voice box and that of the folds
makes our voice distinct from others. An infection of this area by germs,
- bacteria or viruses – can cause swelling and pain and this may also
change the nature of voice. If the swelling gets too much, it may result voice box
in 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 salesman
lose 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, we
can 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 hot
vapour, we will need to retrain our vocal cords by trying to sing out aloud. For infections,
along with breathing vapour, antibiotics may be necessary.
WINDPIPE Knowledge You Can
The windpipe – or trachea (tray- Use
keah) - starts from below the If a sick person with
voice box and ends where it breathlessness produces a
divides into two bronchi (single-
bronchus). You can see rings in
sound, try to clearly make
its entire length. These are bands out if the sound is
of cartilage. They stop the produced while breathing in or
windpipe from collapsing when breathing out.
air is drawn in.
Infections of the windpipe usually go along In swellings of the voice box and the
with infections of the voice box. If the lining wind pipe, we may hear sounds while
swells up, cough results. This cough is usually the person is breathing in air. But if
dry. We may also feel breathless and a strange the sound is accompanied by
sound is produced every time air passes
through the windpipe blocked by the swollen
breathlessness when breathing air out,
and infected lining. the illness is clearly that of the
breathing system below the windpipe!

6. 2-5
BRONCHUS
Bronchus is the pipe that carries air below the wind pipe right to
the lungs. It branches left and right of the windpipe and ends into
very 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 Lining Sweeping away the Germs
The bronchus has a lining inside just The bronchus lining has tiny finger-like structures
like the windpipe, and also has some which act like small brooms. They keep swaying
smooth muscle in its wall. This muscle from one side to the other at all times. Just like the
cannot be moved whenever we want, windpipe and the nose above, they also have sticky
but squeezes or relaxes automatically fluid on it. Outside substances like soot, dust or
when we breathe in or breathe out. germs stick to this. And in this swaying movement,
The brain directly controls these the things that have stuck are handed over from
muscles depending on how much of one finger like structure to the previous one and
oxygen is required for the body. to the next previous one until they can be coughed
out!
Long-Standing Coughs
When we are exposed to tobacco or other smoke for many
years, the lining of our bronchus tends to lose its finger like
structures and cannot produce sticky substance. As a result,
outside dust and germs are no longer trapped and can cause
their harm deep inside.
This is what is called chronic(krau-nik) bronchitis or commonly
called bronchitis. Smokers and old people have this more often
and they lose their power – partially or fully - to resist outside
harm from germs. Hence it is important that such people help their breathing
systems in performing this task. To prevent further damage, these people should
take deep breaths of vapour coming out of water when heated – not boiled – every
day before they sleep in the night. Stopping smoking is obviously very, very important.

7. 2-6
LUNGS
The Lungs are the biggest and most important part of the breathing system.
The two lungs are made of
countless small round
grape like structures, al-
veoli. Through these, oxy-
lungs
gen coming in through our
breathe is given to the blood
in the capillaries.
The grape like structures
also allow carbon dioxide
brought by the blood from
the far off parts of the body
to get thrown into the
grape bronchi and later to be
like alveoli breathed out of the system.
These are pockets of air
surrounded by the The diaphragm is a muscle
tiniest of blood tubes
called capillaries.
between the chest and the ab-
Diaphragm
domen. It moves down-
wards16 to 20 times a minute.
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 walls
that have pores from where blood escapes and stale carbon dioxide gets exchanged
with fresh oxygen.
Bronchus & Bronchioles
The lungs have many Protect children from lung infections
smaller sections; Lung infections are the biggest cause of deaths among
each called a lobe children below five and especially in babies less than
and supplied by one year. Poorly nourished, they cannot fight infections.
small bronchi that Also, their bodies are too weak to cough out the
branch off inside to infections. We need to protect children from lung infec-
smaller bronchi and tions.
bronchioles.
For every child who gets cough, we will have to see that
she gets early treatment. But it is more important to
Usually, in case of an prevent children from getting cough in the first place. Some of these would
infection, it is the en- protect children from getting lung - and some other common infections.
tire lobe that gets
swollen – inflamed – • We will have to see that they live in houses that are
and the person can not crowded.
get fever, cough and • Their houses should have enough windows to allow fresh air
pain in the part of the • Make sure that we have toilets so that children do not step on
chest. This is called eggs of worms when they walk around barefoot and get sick.
pneumonitis or what • Children should get early treatment before they become too
is commonly called weak
pneumonia. to resist other diseases.
• They should get extra food after every illness to help them
recoverthe nourishment they lost by the previous one!

8. 2-7
Know the Answers
The 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 and
danger?
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.

9. 2-8
Diseases of the
Breathing System
What You Will Learn In This chapter
Page Number
1. Common Cold 2-9 to 2-10
2. Stuffy Nose 2-10
3. Coughs
a. what are coughs? 2-11
b. types of coughs 2-12
c. treatment 2-13
4. Bronchitis 2-14
5. Asthma 2-15
6. Pneumonia 2-16
7. Learning to Count Breath 2-17
8.T. B 2-18 to 2-19
9. Allergy 2-20
10. Ear & Its Problems
a. Parts of Ear 2-21
b. Earaches & Infections 2-22 to 2-23
c. Deafness 2-24
11. Throat Problems 2-24

10. 2-9
DISEASES OF THE BREATHING SYSTEM
The breathing system from the nose to the
lungs gives us trouble on a number of occa- General Principles to keep
sions. From simple illnesses like cold and your Breathing System fit
sneezing to serious ones like pneumonia and The lining of the breathing system
TB, we will try to learn more about them in is quite hardy. If it is kept intact
this section. and moist it can help us resist most
For some diseases, we can follow some
infections from viruses and bacteria.
simple and cheap steps to cure them. In many This lining can produce a sticky fluid
we will learn to give medicines carefully. In that traps dust and germs. When this
others we will learn to pick up the signals is produced in large amounts, it even
early enough so that our friends and relatives acts as a filter to clean the air before
in the village can get cheap and affordable letting it get to our lungs.
treatment for them in time.
COMMON COLD
A flowing nose and sneezing are signals that a cold has set in.
The patients’ eyes may be red and bloodshot. The throat feels
sore and a little dry cough may be present. Some may have slight
fever 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 soups
every few hours. You may add ginger and /or Tulsi (Basil) leaves
to the tea. Orange or lemon juice are helpful.
3. Gargling with warm salt water may help to soothe the throat.
Gargle with warm water
4. Vapour inhalation may be taken every few hours.
5. If the fever is too troublesome, you may give the
person 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, one
may add half to one tablet of Chlorpheniramine two to
three times daily – but in children avoid it.

11. 2-10
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 out
viruses and if another person breathes this in, this person will also take in the virus.
Keep door and windows open when many people are
sitting together, even if it is cold.
The sick person should eat and sleep separately; he should
cover his mouth and nose every time he sneezes or coughs.
Eating and sleeping well builds up our resistance and
prevents colds from attacking us.
What NOT to do in a cold?
DO NOT take any antibiotics for a cold as they are of no use and
may cause harm. Colds always go away without medicines.
DO NOT waste money on “cold tablets”, they are no better than
Paracetamol or Aspirin!
DO NOT blow the nose in a cold; wipe it clean – blowing may
push the cold up the ear and sinuses and cause infection there.
STUFFY NOSE
A nose may get stuffy in the latter part of a
cold or due to allergy. In children the
mucus can be pulled out from the nose by
a small dropper or a syringe (without a
needle).
For bigger children, plain or salted water
can be sniffed into the nose.
For those who usually get earaches and sinus problems after colds, one
may use Tablets like Chlorpheniramine twice daily. Or they can use
nose drops of salt water , which can be put into each nostril three times
a day.

12. 2-11
COUGH
You saw earlier that cough is actually our friend. It is a way the
body 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 and
has more fluid. The cheapest and simplest method is to
inhale water vapour.
Taking any medicine that dries the secretion or suppresses
the cough actually helps germs to trouble us more. They
stay in our organs longer and goes deeper to the inner parts.
Scientists still debate if cough syrups are of any use at all.
If at all one takes a cough syrup, see to it that it is marked EXPECTORANT. Avoid any
cough syrup that contains cough suppressants like CODEINE, PHOLCODINE,
DEXTROMETHORPHAN, etc. For children and the aged, these MUST NEVER be used!
We Have More Breathing Dis-
eases in Winters
Inhale Vapour & Breathing diseases are more common in
Cough it out! winters. This is mainly because we tend
to huddle together in the cold and sit
Heat some water – no need to boil closer to one another in closed rooms.
it – until you can see vapour ris-
ing from The chances of sharing our germs in such
it. places become easier. It is better to keep doors and win-
dows open at night and ask people to take an extra blan-
B e n d ket to sleep while sleeping together in a room. Keeping
over the doors and windows closed throughout the night will pre-
pot, cover vent air circulation. It will increase the chance of spread-
your head ing illnesses to another.
with a
towel or
cloth, and
inhale as Children’s Coughs
deep as Children’s coughs and colds are
possible usually due to viruses and there is
several no effective medicine to kill these
times. viruses. Vapour inhalation, good
food and enough fluids make more
The warm vapour will increase the sense than costly antibiotics.
circulation of the lining inside and
Antibiotics are necessary only if simple coughs and
helps it to fight the germs. It also
colds have not got better within seven or ten days or
helps to make the cough more liq-
the person has progressed to other diseases like pneu-
uid so that it is easier to be coughed
monia or TB (see later).
out.

13. 2-12
Types of Coughs
Cough can be due to various reasons. When the air tubes or lungs get infected or when they
face dust, smoke or very hot or cold air, the body defends itself with
cough 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?
Reasons for Coughs
Cough with breath- Cough for long Cough with blood:
lessness and wheezing durations • TB
sound: are suggestive of: • Pneumonia
• Asthma • Smoker • Severe worm
• Whooping • TB infection
cough/ diph- • Asthma • Cancer
theria • Chronic Bronchitis • Heart failure
• Heart trouble • Lung with pus pockets
Dry Cough (without any
phlegm) Cough with Mucus
• Cold
• Bronchitis
• Worms
• Pus diseases of
lung
• Lung infection
• Pneumonia
like pneumonia
• Measles
Cough without fever can be be seen in:
• Smoker’s cough • Allergy
• Worms while passing • Chronic Bronchitis
through lungs • Cancers
• Cold • Rarely in TB
• Asthma • Low fever may
be present in TB

14. 2-13
Different Coughs must be treated Differently
1. For cough with blood
Þ Check if the blood could have come from a bleeding gum or
mouth injury. If there is irritation in the throat as well then
bleeding is from the breathing system. The person needs to
get checked for TB – an X-Ray, sputum examination and a
doctor’s check up will help.
• If a small quantity of blood comes out, it will stop on its
own;
• If it is less than 1 or 2 glasses, calm the person and rest
him in bed.
2. For severe dry cough 3. For cough with mucus
WITHOUT PHLEGM that Þ
disturbs sleeping and rest Loosen mucus by drinking lots of water or hot
Þ Give Tablet or syrup fluids. This is the best - better than any medi-
with CODEINE (but cine.
not to the elderly and to
children below ten Þ
years!). You may give Breathe hot water vapours. Sit down or stand
ASPIRIN next to a vessel with hot water. Cover yourself
and the vessel with a sheet of cloth or towel so
Þ Do not give it CO- that you can breathe the vapours. Breathe deeply
DEINE if there is for 15 minutes. Repeat as many times a day as
phlegm or wheezing possible. This is an excellent remedy for all res-
sound while breathing piratory problems.
in or breathing out.
Þ You can tap the chest from behind for 10 to 15
minutes two times a day, especially for old and
weak people.
Treatment for all
coughs
Þ Grind some Tulsi (Basil)
leaves to get a spoonful of
juice. Mix with one spoon of
honey and one spoon of
lemon/orange juice. Give
every two –three hours or so.
Þ Give tea with ginger / tulsi
leaves every few hours
DO NOT ALLOW SMOKING.

15. 2-14
Bronchitis
Bronchitis happens when the tubes going from the windpipe
downwards 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 also
be used.
2. Lower fever with cold compresses or PARACETAMOL;
keep giving hot fluids and vapour inhalations.
Bronchitis
3.Children’s bronchitis are mostly due to a virus. - noisy cough; breath-
Antibiotics will not help. Only if the bronchitis lasts more than less
a week and if it is not getting better, or if it is worsening to
pneumonia, give antibiotics like COTRIMOXAZOLE or
AMOXYCILLIN.
What not to do How do we stop Bronchitis from
in Bronchitis? spreading to others?
Do not rush for 1. Ask the person to cover his mouth
with his hand or handkerchief while
antibiotics.
coughing.
DONOT allow 2. Collect the phlegm or mucus on a
smoking. piece of paper and burn it or bury it
well.
Chronic Bronchitis
Cough with mucus that occurs at least three months a year and keeps coming back every
year 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 or
Asthma(see later), the person has Chronic Bronchitis.
Usually seen in older people and those who have smoked heavily, it can lead to a disease of
the lungs in which pockets of the lungs break down. In this disease, the person remains out of
breath all the time.
What to do in Draining
Chronic Bronchitis? Out Phlegm
Þ STOP SMOKING For old and weak
Þ Take SALBUTAMOL three to four people, help with
times a day. draining out the
Þ Every time there is severe cough with phlegm and pus can
fever, take antibiotic like be given. After in-
COTRIMOXAZOLEor haling vapour, the
DOXYCYCLINEor person should lie on
AMOXYCILLIN his belly on a cot
Þ Hot water vapours help a lot and and his chest and
must be taken at least once a day, head must lean forward onto the ground hanging over
especially at night. the edge. Tap on the back to loosen the mucus.

16. 2-15
ASTHMA Asthma Attacks
The muscle in the wall of the bronchi that must relax and squeeze
and allow breathing may not do so because of some problems.
A common problem that may occur is that the muscle may squeeze
too much. This causes breathing difficulty as the usual amount of
used air having carbon dioxide is not exchanged. This ailment is
bronchial asthma or commonly called asthma (asth-mah).
Sometimes, the muscles can squeeze all of a sudden and to such
an extreme that the person may no longer be able to breathe and
may even die.
Asthma could be due to allergy when the lining of the bronchus in In Asthma attacks,
the lungs reacts to some substances it comes in contact with. The the person finds
allergy that causes asthma can be due to various things, like flower diffculty in breathing
pollen, dust, cold air etc.
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 more
than three days, start Tablet COTRIMOXAZOLE twice
a day.
3. Give lots of fluids to loosen the mucus.
4. For mild attacks, start SALBUTAMOL. If already on
Salbutamol, 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 chicken
or 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 on
SALBUTAMOL 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.

17. 2-16
PNEUMONIA
Inflammation of the lungs in response to infection or to harmful fumes and
gases is called pneumonia. Like in all inflammations, the lungs too swell;
there is pain, redness, heat and decreased functioning. It is quite common
in young children and in the aged.
Pneumonia happens when we breathe in viruses and bacteria that other people
are breathing or coughing out. Pneumonia is serious – it can kill! It is one of
the largest killers of children and the aged. It needs to be identified early and
treated fast.
Detecting Pneumonia How to know whether it is
Usually affecting one part of the lung, pneu- common fever or pneumonia?
monia should be suspected if a person has:
Breathing becomes faster even with simple
Cough, often with yellow, greenish
or rusty, blood coloured mucus fevers. Therefore, it may be difficult, espe-
High fever (fever may be low in cially with children, to say if the rapid
elderly people) breathing is due to simple fever or due to
Pain in some part of the chest, pneumonia, which also may give fever.
especially while breathing deeply
Difficulty in breathing, and To differentiate, one should count the
Rapid shallow breathing breathing rate and the pulse rate at the same
time. Normally, the pulse is about four
Signs of Serious Pnemonia times the breathing rate. If the ratio is less
Along with the above: than four is to one, it is highly likely that
* If the muscles between the ribs are drawn in (pulled the problem is not just simple fever, but a
inwards) every time the child breathes
problem with the breathing system, e.g.
* If the person is unable to eat or drink. pneumonia.
What to do in Pneumonia? Count breathing of babies
1. Start COTRIMOXAZOLE or AMOXYCILLIN in full to detect pneumonia fast
doses immediately. If serious, send for help, but after Pneumonia can kill babies very
starting the treatment. fast. We should suspect
2. Give PARACETAMOL if fever is high and to lessen pneumonia and start antibiotics
pain. immediately if:
3. Give plenty of hot fluids especially like tea, coffee or * A child less
soups. If person is not eating, liquid foods or than one
rehydration drinks may be important. month
4. Get the person to breathe hot water vapour. Body breathes fifty
down shallow
drainage may also help. breaths and
more in a
5. If the person is wheezing, SALBUTAMOL will help.
minute.
6. Serious Pnemonia will need * If a child
injcetions. Refer the person IM- who is between 1 month
and 1 year old breathes forty
MEDIATELY to a hospital ! shallow breaths and more
in one minute.

18. 2-17
LEARN TO COUNT THE BREATH
A normal adult breathes about sixteen to twenty times every minute. But when the
lung is diseased, as in the case of pneumonia, a person will have to breathe more in
a minute. This is because only those parts of the lung that are not infected will
work well. And these parts may be unable to provide all the oxygen that the body
needs. Therefore, quicker and more breaths per minute tell us about a problem
with the breathing system.
What we need to count is the breathing rate when the body is at rest. All that we
need to do is to look at the chest going up and down for a minute to count the
breathing rate. But it is not as easy as it seems. Most people will get conscious of
their breathing when they are being watched. It will make them take deeper
breaths 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. But
when sleeping, the movement of the chest is not so obvious. It would then help if
you keep a piece of paper in front of the nose and count its movement each time
the person breathes out.
Practise Counting Of Breath
We can count breathing in another way that would make the person less conscious
that you are actually counting her breath.
Hold the person’s wrist and make it look as if you are measuring her pulse. Instead
your attention should be on her chest and her breathing. By a side-glance you should
be able to count her actual breathing rate.
Try this out with a partner
Make 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.

19. 2-18
TUBERCULOSIS (T.B)
Tuberculosis or TB is a disease of the poor. Poor nutrition, bad housing and a lack of education
are the main reasons why TB is common in a community. It usually occurs in poor people or
those 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, their
housing 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 the
lungs. A small but hardy bacterium called Mycobacterium
tuberculosis is present in more than half the people of India beyond
the age of forty. In some of those who have the infection, disease of
tuberculosis may occur sometime during their lifetime.
Less than half of all patients who have the TB disease and do not
take any treatment may bring out the germ in their mucus. In damp
atmosphere and in congested places, anyone nearby is likely to
breathe in the germ and get infected. In those who are poorly
nourished, 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 common
symptoms, but point towards
TB if they persist even after
three weeks.
As the breathing system is at-
tacked by the bacterium in
most cases, any cough last-
ing more than three weeks
should also make one sus-
pect TB.
TB can also happen in other
parts of the body. Apart from
fever and loss of weight, the
person may have small
glands in the neck (lymph
glands), inability to bear chil-
dren (ovary and tubes), lumps
in the abdomen (abdominal
TB) or severe pain in the big
joints.

20. 2-19
What to do for T.B?
To all patient with symptoms of T.B, first give an antibiotic like COTRIMOXAZOLE for five
days. If the symptoms continue:
• Ask the person to collect the mucus (the fluid that comes with coughing) from his early morning
cough 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 not
help confirm whether there is T.B or not.
If the person has T.B, medicines should begin
immediately. As there are many schedules of different
medicines that can be given for TB, request the treating
doctor to start a schedule that the person can afford.
Different types of drugs are of different costs and an affordable schedule is
important. If the person starts and stops treatment repeatedly, the germ is
likely to get resistant to the usual medicines. It is said that it is better not to
treat a person’s TB than to treat halfway! The fastest course to treat T.B requires
four drugs to be taken for two months followed by four months of two medicines
only.
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.
How do we stop T.B from spreading to others?
ONLY a person with cough show-
ing a positive result for TB can
spread it to others. Those testing
postive for T.B should:
• Try to sleep in a separate room
or if not possible then sleep in a
room with open windows for
ventilation
T.B spreads through breathing and coughing.
• Cover the mouth while coughing. Person with T.B should stay in separate room
or a well ventilated room from family.
• 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 the
next two years the family members should also be under watch for the disease.

21. 2-20
ALLERGY
Though not a disease of the breathing system, allergy is a reaction that occurs only in some people
due 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 some
flowers 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 to
things 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 Sulpha
tablets are well known.
Some Common Things that People develop Allergy Towards
certain foods
some drugs; sulpha; or
penicillin injections
animal
feathers;
fur
plants or some
herbs
alcoholic some animals like
drinks cats, dogs etc.
old and mouldy
blankets, pillows
etc
Allergy reactions can be mild What to do for Allergies?
or serious:
On the skin, the person may get
1. Try to find out
rashes, or lumpy patches which drug or
Some may get a stuffy nose and re- thing one reacts
peated sneezing to and avoid
Irritation in the throat, which may
lead further to difficulty in breathing them.
or an attack of asthma.
Allergic shock — the person may col- 2. Tab CHLORPHENIRAMINE
lapse and his pulse and BP may be very
low.
or PHENIRAMINE twice a
Diarrhoea in some children, who day helps in reducing the
react to milk or to wheat products. reaction.

22. 2-21
Ears
Ear complaints come second to complaints
about the teeth whenever school children are
examined for health problems. Pus coming out
of the ear again and again and ear ache are
very common.
Ear structure
The ear has three parts. The outer ear has
the ear canal and the pinna, the flap like piece that can be moved around in animals- and
by 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 vibrates
with 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 middle
ear is also connected to the throat through a tube that helps to balance the air pressure
on each side of the eardrum.
The inner ear has the specialised snail shell. It is really special, for it is here that sound vibrations
received from the outer ear get changed into electrical signals. These signals when sent to the
brain help us understand the different sounds. The inner ear also has three half-circle canals
that help us understand how our body is positioned. Signals from the half-half-circle canals in
the ears and signals from the eyes are jointly analysed by the brain to understand whether the
person is standing, lying or is unstable.
Parts in The Human EAR
Half Cirlcle Canals
Pinna for balancing body
Outer Ear
Nerve
Ear Canal
Inner Ear
- has snail shell; sends
Ear Drum sound signals to brain;
- outer Ear end has tubes which keep
in ear drum Middle Ear body balance
- from ear drum on-
wards; has small bones;
sends vibrations to inner
ear; balances pressure
on eardrums

23. 2-22
If something enters the ear
Children may push foreign bodies inside their ears. Only if
they are quiet and restful should one attempt to pull it out.
It is always better to send the child for medical help where
the child is given some medicine to sleep and then the foreign
body is taken out with special forceps.
If an insect has gone in, it is important to kill the insect first
before trying to pull it out. Drop warm coconut or baby oil
in the ear and then flush everything out with a syringe Children can be taught to check
(without needle) with warm water. the ears of their siblings from
time to time
EARACHE and EAR INFECTIONS
As said earlier, earache is very common, especially among children. Although earache is more
common due to reasons in the outer ear, it may also be due to infections in the middle ear. Ear
wax, boils, a foreign body or a small injury while ’trying to clean’ the ear are the most common
causes of earache. Sometimes, toothache and mumps may also appear like earache.
Commonest Places of Ear Infections
The ear tube from the middle ear to the throat is the commonest
reason for infections reaching th ear. Especially during colds, if
we pinch our nose and blow hard, the infection may travel
into the middle ear. Here, there is limited space and if pus has
formed, 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 enters
accidentally while bathing or swimming. Repeated infections
can spoil the small bones and the middle ear so that the sound
from the outer ear is not transferred to the brain correctly.
1. Infection of Outer Ear
If we want to know whether only the outer ear is infected, we can pull lightly on the pinna or
press on the small knobby structure that guards the ear canal. If the pain increases by this, we
know 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 cotton
wrapped on a match stick or a clean broom twig.
Mix one spoon of vinegar with one spoon of boiled water, and
put a few drops of this into the ear 3 to 4 times a day.
If there is fever as well, give COTRIMOXAZOLE or
AMOXYCILLIN by mouth for five days.
For relief from pain PARACETAMOL or ASPIRIN may be
given.

24. 2-23
2. Infection of the middle ear
The 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 head
can tell us about infection of the middle ear. At times there is pain in the ear as well. The ear
infection keeps coming again and again unless treated well the first time itself.
What to do if middle ear is infected?
Give COTRIMOXAZOLE or AMOXYCILLIN by
mouth for seven to ten days.
PARACETAMOL or ASPIRIN for relief from pain
may be given.
Carefully clean the pus out of the ear canal with
some cotton wrapped on a matchstick or a clean
broom twig.
DO NOT allow such children to swim. They may have a bath, but be careful that no water gets
in 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 during
a cold.
Keep the child on a nutritious diet always.
DO NOT FEED a child with a bottle while she is lying on her
Teach children not to
blow their nose when back as it may flow back through her ear tube from her throat
they have a cold into her middle ear.
3. Inner Ear Infections
Half-circle canals in the inner ears help us keep our body balance. If there are repeated
middle ear infections, the infection may travel to the inner ear and may also destroy the
semi-circular canals. This may cause problems in understanding the posture and lead to
a sense of imbalance.
EARWAX Squirt warm water with
Earwax is normal. To keep the ear clean, gently clean with syringe (without needle) to
cotton or the rolled end of a cloth. clean inside of ears
If it is too much and one gets itching, loss of hearing or a
ringing sound in the ear, one can put 3 to five drops of clean
oil daily for three days to soak it and then ask someone
trained 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 the
chemist’s shop, but usually these are not necessary.

25. 2-24
DEAFNESS
Deafness Is Caused By :
Either middle ear infections, earwax or due to a problem with
the nerves going from the ear to the brain.
Some drugs like Aspirin and Streptomycin (for TB) in large doses
may also cause deafness.
Children may be born deaf if their mother suffered from some
illness 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 cause
is found, try to treat it at the earliest.
Using Hearing Aids
Hearing aids or machines help to Note: If a government ENT
increase the energy of the sound that specialist or District Civil Sur-
goes till the inner ear. In people who are geon certifies that a person is
partially deaf, they can help in hearing hard of hearing, a person can
better. get an electrical hearing aid free
of cost from the government
If the eardrum has got punctured either through the district social wel-
by infection or accidentally while fare department.
‘cleaning’ the ear, nowadays there are
operations these days to help repair the
eardrum.
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. Drinking
cups of hot ginger tea can do wonders to a sore throat.
• If the voice has cracked, breathe some hot vapour as discussed Gargle with warm
earlier – the more times a day we can take, the better for us!. water
• A type of bacteria – that causes sore throat can also harm the
heart 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 throat
again and again or they have already got the heart disease, it makes
better sense to give them a monthly
injection of Penicillin!

26. 2-25
Know the Answers
Diseases 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 way
that 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.