Dr. M.S Kanwar

Dr. M.S Kanwar 🗣 More than 47 years of experience
👨🏼‍⚕️ Senior Consultant & Advisor, Pulmonary, Apollo Hospital

29/03/2026

🦠 Why Is Your Cough Not Going Away This Season?

“It’s just viral…” — but then why is it lasting 2–3 weeks?

This winter, many patients are experiencing persistent cough, fever, and throat irritation that just doesn’t settle quickly.
Dr. M. S. Kanwar explains the real reason behind these prolonged infections.

⚠️ What’s Happening This Season?

Multiple viruses are circulating at the same time, including:

• (most dominant currently)
•
•
•
•
•

👉 These viruses spread very fast and can infect repeatedly or overlap

😷 Why Symptoms Last Longer Now

• Reinfection or overlapping infections
• Stronger viral strains like H3N2
• Post-viral inflammation (cough continues even after infection settles)
• Weak immunity or exposure in crowded environments

🚨 Common Symptoms

• Persistent cough (1–3 weeks or more)
• Fever on and off
• Throat irritation
• Body aches & fatigue

🛡️ What You Should Do

✔ Don’t ignore prolonged cough
✔ Avoid self-medication repeatedly
✔ Take proper medical advice if symptoms persist
✔ Follow precautions: mask, hygiene, avoid crowded exposure

🎯 Key Takeaway

Not all viral infections resolve in 3–4 days anymore.
This season’s infections are stronger, longer-lasting, and highly contagious.

Early care = faster recovery + fewer complications

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RespiratoryHealth Pulmonology StaySafe 🦠🫁

21/03/2026

🫁 Understanding a “Commonly Seen Yet Called Rare” Lung Disease

Many lung diseases that were once considered rare are now being seen more frequently in clinical practice.

One such condition is Pulmonary Fibrosis, where the lung tissue gradually becomes scarred and stiff, affecting normal breathing.

🔍 What Happens in the Lungs?

• Progressive scarring (fibrosis) of lung tissue
• Reduced lung volume and elasticity
• Air trapping and airflow limitation
• Decreased oxygen exchange

Over time, the lungs lose their ability to expand properly, leading to:

• Persistent cough
• Breathlessness
• Reduced exercise tolerance

⚠️ Why It’s Called “Rare” but Seen Often

Earlier (20–40 years ago), such conditions were truly rare.
But today:

✔ Better awareness
✔ Advanced CT imaging
✔ Increased environmental exposure

👉 Have made these conditions more commonly diagnosed

So while still labeled “rare,” they are clinically more frequent than before.

🧬 Related Condition to Know

Another important condition is Sarcoidosis:

• Can affect lungs and other organs
• May cause joint swelling and systemic symptoms
• Often easier to diagnose and manage with timely treatment

🎯 Key Takeaway

🩺 Not all “rare diseases” are truly rare anymore.
🫁 Early symptoms like chronic cough or breathlessness should never be ignored.
⏳ Early diagnosis = Better control and prevention of long-term lung damage.

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EarlyDiagnosis RespiratoryCare 🫁

18/03/2026

🫁 Case Update: Timely Treatment Prevented Permanent Lung Damage

This 55-year-old patient diagnosed with Hypersensitivity Pneumonitis showed a strong recovery with the right medical approach and timely intervention.

💊 Treatment Approach

The patient was managed with:

• Steroids to reduce lung inflammation
• Mycophenolate (immunosuppressive therapy) to control immune overreaction
• Supportive care for oxygen and symptom relief

---

📈 Clinical Improvement

✔ Symptoms significantly reduced
✔ Oxygen levels improved and stable
✔ Patient maintaining well even on exertion
✔ Overall condition much better

---

🔍 Most Important Finding

✅ No fibrotic changes seen in lungs

This is crucial because fibrosis (scarring) can lead to permanent lung shrinkage and long-term damage.

👉 In this case, early diagnosis + proper treatment helped prevent that stage completely.

🩺 Key Message

In Hypersensitivity Pneumonitis:

• Early treatment can reverse the disease
• Delay can lead to irreversible fibrosis
• Preventing exposure is as important as medicines

🎯 Takeaway

We didn’t just treat the disease — we prevented long-term lung damage.

The patient is now stable, improving, and holding well — a strong example of how timely pulmonology care can change outcomes.

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EarlyDiagnosis PreventiveCare 🫁

17/03/2026

🫁 Case Insight: When the Same Exposure Triggers Lung Disease Again

A 55 year-old patient presented with breathlessness, cough, and fever — symptoms that pointed toward a rare but important condition: Hypersensitivity Pneumonitis.

🌿 What Caused It?

In the Indian setting, one of the most common triggers is bird exposure, especially:
• Pigeon droppings
• Parrot exposure

These antigens, when inhaled over time, can cause lung inflammation and damage.

📊 Clinical Findings

• Breathlessness and persistent cough
• Fever and chest discomfort
• Drop in oxygen levels
• CT scan showing ground-glass opacities (a key radiological sign)

🔄 The Turning Point (Relapse Story)

✔ The patient was treated in 2022
✔ Recovered completely within 6 months
✔ CT scan became normal
✔ Treatment was gradually stopped

However…

⚠️ After re-exposure to pigeons, the same symptoms returned
⚠️ CT again showed ground-glass changes
⚠️ Oxygen levels dropped once more

This clearly highlights a classic relapse due to repeated antigen exposure.

🩺 Key Medical Message

Hypersensitivity Pneumonitis is not just about treatment — it’s about strict prevention.

Even if you recover completely:
❗ Re-exposure can restart the disease
❗ Lung damage can become permanent over time
❗ Recurrent episodes can lead to fibrosis

🎯 What Patients Must Understand

• Avoid the trigger completely (especially bird exposure)
• Follow medical advice strictly
• Do not ignore early symptoms
• Prevention is more important than treatment

💡 Real Takeaway

Treatment can heal the lungs… but exposure can damage them again.
Your environment plays a bigger role than you think.

---

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PreventionIsKey RespiratoryCare 🫁

14/03/2026

🫁 Case Study :Recovery Phase After Severe Multi-Organism Pneumonia

This patient, previously treated for Breast Cancer, developed a severe and life-threatening Pneumonia due to multiple pathogens because of a weakened immune system.

the patient showed remarkable clinical recovery.

✔ Oxygen levels improved to 98–99%
✔ Breathlessness reduced significantly
✔ The lung cavity has now disappeared on imaging
✔ Only a mild residual inflammatory shadow (~30%) remains

🩺 Current Treatment Decision

During the recovery phase, treatment adjustment becomes equally important.

Since the Candida tropicalis infection has resolved, one of the expensive antifungal drugs (Endol) can now be stopped for the next week, while the remaining treatment continues.

This careful step-down approach helps:

• Avoid unnecessary medication exposure
• Reduce treatment cost
• Ensure infections do not relapse

⏳ What Happens Next?

Residual lung shadows after severe pneumonia may take 4–6 weeks to completely resolve.

The current plan is:

• Continue treatment and monitoring
• Repeat evaluation in 7–10 days
• Observe gradual clearing of remaining lung shadows

🎯 Key Medical Insight

In immunocompromised patients, infections can involve multiple organisms simultaneously, sometimes leading to respiratory failure and ICU admission.

Successful treatment requires:

✔ Early aggressive therapy
✔ Covering all possible pathogens initially
✔ Carefully deciding what to continue and what to stop as the patient improves

Medicine is not only about starting the right drugs — it is also about knowing
it is also about knowing when to safely stop them.

📞 For Physical Consultation (India):
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CaseStudy RespiratoryMedicine CriticalCare 🫁🩺

13/03/2026

🫁 Case Study: Recovery After Severe Pneumonia

This patient, who was previously immunocompromised after treatment for Breast Cancer, had developed severe multi-organism Pneumonia with cavity formation in the lung.

After aggressive treatment with intravenous antibiotics, antifungal therapy, and antiviral coverage, her clinical condition improved dramatically.

📊 Current Clinical Status

• The patient is now clinically stable
• Oxygen saturation has improved from 81% → 98–99%
• Breathlessness has significantly reduced
• No new symptoms or complications are present

🩻 Latest Imaging Findings

The most recent CT scan shows:

• No visible cavity now
• Only a faint residual shadow remains
• The lesion has shrunk significantly (around 70% improvement)
• Approximately 30% mild inflammatory shadow is still visible

This residual shadow is expected during the healing phase after severe lung infection.

💊 Treatment Plan Moving Forward

Since a small residual infection/inflammation is still present:

• Current medications will be continued for about one more week
• This ensures complete resolution of infection
• Prevents relapse or incomplete healing

Even though the medicines may be expensive, finishing the full course is crucial for complete recovery.

🎯 Key Medical Message

In severe pneumonia, especially in immunocompromised patients, imaging abnormalities can take time to completely disappear.

Clinical improvement often occurs earlier than radiological healing, which is why continuing treatment until full resolution is essential.

Early aggressive treatment and careful follow-up can convert a life-threatening infection into a full recovery.

📞 For Physical Consultation (India):
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RespiratoryMedicine MedicalEducation 🫁🩺

12/03/2026

🫁 CASE STUDY
When Pneumonia Becomes Life-Threatening

Immunocompromised patient
Multiple infections in the lungs
Cavity formation on CT scan

➡️ How aggressive treatment reversed a critical condition

A patient undergoing treatment for Breast Cancer developed severe immune suppression after recent radiation therapy. She presented with high fever, breathlessness, and dangerously low oxygen levels (around 81%).

CT imaging revealed extensive right-sided lung infection consistent with severe Pneumonia, along with large cavity formation in the lung — a serious complication seen in aggressive infections.

Further evaluation showed that this was not a single infection, but a complex multi-organism pneumonia.

The patient had infections caused by:

• Klebsiella – bacterial infection
• Aspergillus – fungal infection
• Candida tropicalis – fungal infection
• P*P (Pneumocystis Pneumonia)
• Cytomegalovirus Infection

This meant bacteria, fungi, and viruses were all affecting the lungs simultaneously — a situation often seen in severely immunocompromised patients.

⚕️ The treatment required aggressive multi-layered therapy:

• Intravenous antibiotics
• Antifungal medications
• Targeted treatment for P*P
• Antiviral coverage for CMV
• Intensive supportive care

Within a few days of comprehensive treatment, the patient began to clinically improve.

Follow-up imaging showed remarkable recovery:

✔ The lung cavity gradually shrank
✔ Eventually the cavity almost disappeared
✔ Oxygen levels improved from 81% → 98–99%

This case highlights a critical lesson in respiratory medicine:

⚠️ Severe pneumonia in immunocompromised patients can involve multiple pathogens simultaneously.
✅ Early aggressive treatment can reverse even life-threatening lung damage.

Timely diagnosis, comprehensive microbial coverage, and close monitoring can truly save lives.

📞 For Physical Consultation (India):
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CaseStudy CriticalCare RespiratoryMedicine MedicalEducation 🫁🩺

11/03/2026

🫁 CASE STUDY

Life-Threatening Pneumonia in an Immunocompromised Patient

Breast cancer treatment → immunity weakened
Severe lung infection with cavity formation

A patient undergoing treatment for Breast Cancer had recently received radiation therapy and multiple antibiotics. Such treatments can weaken the immune system, making the body vulnerable to serious infections.

She presented with severe breathlessness, fever, and falling oxygen levels. CT imaging revealed extensive right-sided lung infection consistent with severe Pneumonia, along with a large lung cavity — a serious complication often seen in aggressive infections in immunocompromised patients.

Because her immunity was already compromised, the infection progressed rapidly and became life-threatening.

However, with timely diagnosis, targeted treatment, and careful monitoring, the outcome improved significantly.

Follow-up imaging after a few months showed a remarkable change:

• The large cavity had almost disappeared
• Pneumonia had significantly resolved
• Lung structure and oxygenation improved

This case highlights an important lesson in respiratory medicine:

⚠️ Immunocompromised patients can develop extremely severe infections
✅ Early detection and appropriate treatment can reverse even dangerous lung damage

Accurate imaging, timely treatment, and close follow-up can make a life-saving difference.

📞 For Physical Consultation (India):
9899988653 | 9716415790 | 9971000634

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WhatsApp/Call: +91 9910319688

CTScan RespiratoryMedicine MedicalEducation 🫁🩺

🩺 Case Study: When Enlarged Chest Glands Reveal the Real DiagnosisA patient presented with enlarged mediastinal lymph no...
10/03/2026

🩺 Case Study: When Enlarged Chest Glands Reveal the Real Diagnosis

A patient presented with enlarged mediastinal lymph nodes near the airway where the windpipe divides into right and left bronchi. To identify the exact cause, we performed (EBUS-TBNA) — a minimally invasive procedure that allows ultrasound-guided sampling of chest lymph nodes.

During the procedure, multiple enlarged glands were visualized. To ensure diagnostic accuracy, 6 needle passes were taken from different areas, collecting 24–26 tissue samples.

Initial tests showed negative TB markers, while (ACE) levels were elevated (115), suggesting a granulomatous inflammatory condition.

The biopsy report confirmed chronic granuloma. Importantly, there was no caseation necrosis, a feature commonly seen in . Absence of necrosis favors , which presents with non-caseating granulomas.

✅ Final Diagnosis: Sarcoidosis
💊 Plan: Appropriate sarcoidosis management with regular follow-up and monitoring.

Key Message: Not every enlarged chest gland is TB or cancer. Accurate tissue diagnosis ensures the right treatment.

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AccurateDiagnosis RespiratoryMedicine 🩺🔬

09/03/2026

🔬 When Biopsy Confirms the Diagnosis

After detailed evaluation and tissue sampling through
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA),
the pathology report revealed chronic granuloma.

But granuloma itself is not the final disease — it is a pattern of inflammation that can occur in different conditions.

🧠 The Two Major Clinical Possibilities

In such cases, the main conditions doctors consider are:

• Sarcoidosis
• Tuberculosis

Both can produce granulomas in lymph nodes and lung tissue.

🔎 The Key Differentiating Feature

The biopsy report showed:

✔ No caseation necrosis
✔ No tissue dissolution inside the granuloma

This is important because:

• Tuberculosis usually shows caseating necrosis (tissue breakdown).
• Sarcoidosis typically shows non-caseating granulomas.

Since necrosis is absent, the findings do not support TB.

📄 Final Interpretation

The pathology report, combined with clinical findings, strongly favors sarcoidosis.

This confirms the clinical diagnosis of sarcoidosis.

🩺 What Happens Next?

Treatment will now be directed toward sarcoidosis management, which may include:

• Anti-inflammatory therapy
• Careful monitoring of lung and lymph node involvement
• Periodic follow-up imaging and clinical assessment

Early diagnosis allows proper treatment and prevents unnecessary therapies.

📌 Key Message

Granuloma alone is not the diagnosis.
Clinical correlation + biopsy interpretation leads to the final answer.

In this case, the evidence supports sarcoidosis rather than tuberculosis.

📞 For Physical Consultation (India):
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AccurateDiagnosis RespiratoryMedicine 🩺🔬

08/03/2026

🔬 When the Diagnosis Becomes Clear

During evaluation of enlarged mediastinal lymph nodes, we performed
(EBUS-TBNA) to obtain tissue samples.

🩺 How the Sampling Was Done

Using real-time ultrasound guidance:

• The needle was inserted into the lymph node
• The needle was rotated at different angles (about 90°) to obtain adequate tissue
• Multiple passes were taken to ensure diagnostic accuracy

In this case:

✔ Around 6 passes were taken
✔ Samples from different lymph node areas
✔ Approximately 24–26 tissue cores/smears collected

This improves the chances of reaching a reliable diagnosis.

📊 Initial Laboratory Findings

Some markers suggested an inflammatory granulomatous process:

• Tuberculosis-related tests – negative
• (ACE) level elevated – 115

However, laboratory markers alone cannot confirm the diagnosis.

📄 Final Pathology Report

The biopsy report clearly states:

“Consistent with chronic granuloma.”

Granulomatous inflammation may be seen in conditions such as:

•
•
• Certain chronic infections or inflammatory disorders

Clinical correlation and complete evaluation help determine the exact cause.

🎯 The Key Message

Imaging can raise suspicion.
Blood tests may suggest possibilities.

But tissue diagnosis gives the answer.

That is why procedures like EBUS-guided biopsy are crucial in modern respiratory medicine.

📞 For Physical Consultation (India):
9899988653 | 9716415790 | 9971000634

🌍 For International Online Consultations:
WhatsApp/Call: +91 9910319688

LungDiagnostics BiopsyMatters 🩺🔬

07/03/2026

🔎 Enlarged Chest Lymph Nodes — TB, Sarcoidosis or Lymphoma?

When we see enlarged mediastinal lymph nodes during evaluation or (EBUS-TBNA),
there are usually 2–3 major possibilities:

• Tuberculosis (TB)
•
•

Sometimes infections may also mimic these conditions.

🤔 The Diagnostic Challenge

Symptoms are often confusing.

In TB & Sarcoidosis:

Many times, major symptoms are absent.

Patients may only have: • Weakness
• Tiredness
• Mild or intermittent fever
• Slight weight loss
• Occasional cough

In several cases, it is picked up accidentally on imaging.

In Lymphoma:

Usually, there are additional warning signs: • Persistent fever
• Night sweats
• Significant weight loss
• Generalized lymph node enlargement

But again — not always textbook.

⚠ Why Biopsy Is Essential

Until we PROBE the lymph node and get tissue confirmation:

We cannot start treatment.

Because treatment for all three conditions is completely different.

• TB → Anti-tubercular therapy
• Sarcoidosis → Steroids / Immunomodulators
• Lymphoma → Chemotherapy

Giving the wrong treatment can be dangerous.

For example:

If steroids are given assuming sarcoidosis,
but the patient actually has TB — infection may worsen.

If anti-TB drugs are given blindly in lymphoma — valuable time is lost.

🎯 Diagnosis Before Decision

Medicine is not assumption-based.

It is: Imaging → Tissue Diagnosis → Targeted Therapy

That is why procedures like EBUS-guided biopsy are crucial.

🩺 Final Message

Not every enlarged gland is TB.
Not every case needs immediate steroids.
Not every swelling is cancer.

But every suspicious node needs confirmation.

For Physical Consultation (India):
📞 9899988653 | 9716415790 | 9971000634

🌍 For International Online Consultations:
📞 WhatsApp/Call: +91 9910319688

MediastinalNodes Pulmonology AccurateDiagnosis BiopsyMatters

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✴ Dr. M.S.Kanwar has 45 years of experience in handling Critical Care, Acute and Chronic Respiratory diseases like Asthma, COPD Allergies, Lung Infections, Interstitial Lung Fibrosis, Sarcoidosis, and Lung Cancer.

✴ He is a Pioneer in Sleep Medicine in India and started this field for the first time in a big way in 1995 when he set up Asia's Largest and State of the Art Sleep Lab at Indraprastha Apollo Hospital, New Delhi. His team had done the largest Sleep studies in the country and he gets referrals for Sleep consultation from abroad also. His research papers on Sleep Apnea have been presented in the world conferences on Sleep Medicine.

✴ He is currently leading the Lung Transplant Program at Indraprastha Apollo Hospital, New Delhi. He is involved in training the Lung Transplant staff as well as in spreading the awareness on this cutting edge technology among physicians and the general public because this is a new life-saving modality in severely crippled Lung Failure cases.

✴ He had completed his M.B.B.S, M.D from Govt. Medical College, Amritsar and D.N.B ( Respiratory Medicine ) from National Academy of Medical Sciences, New Delhi. He did a Fellowship exam ( Cardiology ) by the University of Vienna ( Austria )after completing training in Rudolfstiftung Hospital, Vienna. He received Pulmonary and Critical care training from famed Mayo Clinic, Rochester( USA ). He also received Sleep Medicine training from Mayo Clinic Rochester. He received training an Echocardiography training at the University of Alabama, Birmingham( USA ). He received training in Lung Transplantation at UNH ( University Network Hospital), Toronto Canada.