Author: ATTY ALEXIS C. ALBAO, MD, MHA, CSEE

COVID-19 Pandemic brings to fore various behavioral reactions of different sectors of the society, worldwide, and it seems that everybody was caught by total surprise. There is lockdown and other terms that could only be heard today.

From the standpoint of one of the COVID-19 sufferers, she testified that the virus causes irritation of the throat, causes dry cough and thereafter causing fever, as substantial full manifestation of the disease. I doubt if others would testify otherwise, or testify that the initially affected area is not in the respiratory tract.

If the dilemma materializes in the respiratory tract of a person, specifically in the throat, why focus too much on various areas or venues, e.g. too much concern on quarantine pass, where the battle against a virus can be won? Of course, it is not likely on the surfaces, paper money bills or hands, etc., where this virus comes in contact with, either accidentally or {maybe} intentionally, but on the part of the human body, where it first manifests. In short, focus also the efforts in the part of the body, where it first manifested.

Above principle makes the face masks and protective devices, including the traditional preventive health measures, social distancing, lockdown policy, test oriented and hospital care approach as false  assurance in resolving COVID-19 problem. For example regarding lockdown in the Philippines, one policeman already succumbed to the virus. And while it is true that majority are at home quarantine, enforcers, e.g Local Chief Executives, police and the military, including the national officials, are mobile.

Also, the Department of Health and health personnel themselves become the easy target of transmission because DOH allows delivery trucks to deliver important logistics to the region and other places, without assurance that the delivery trucks are sanitized, whereas, health personnel are not in lockdown.  Even if the trucks are sanitized, there is no assurance that from Manila to Bicol, for example, the truck, the driver and his companion are still free from virus.

This is also true to merchandise being delivered to other places, which can not be put on lockdown. Otherwise, Filipinos will die of hunger. Based on the above reasons, the effectiveness of lockdown alone would be in question. And nothing is wrong,  if other remedy be supplemented to lockdown.

An alternative remedy must thus be explored and considered. This is because above measures are bound to fail due to enormous factors to consider especially if thousands are affected. This is where the discovered alternative steam inhalation therapy would come in. As noted, it is not expensive. Also, it does not mandatorily require any governments’ primary efforts, but may only require them to do a supporting role of educating their citizens on the use of steam inhalation therapy, subject, however, to their compelling role  to mandatorily require its use due to emergency for the protection and welfare of others. This is because  steam inhalation therapy is more of a personal obligation, or if patient is in a hospital or seen by a doctor/health worker, the use of the therapy is more part of their professional obligation.

Why not wipe out today the virus though steam inhalation therapy, instead of putting the people tomorrow at risk, as they can not be handled by the present health care system?

Background of the discovery

This is based on the recent personal experience of the author. The preventive and curative importance of the therapy was deeply understood by him during his confinement at a hospital due to water retention secondary to congestive heart failure, pneumonia and amiodarone lung toxicity, with persistent coughing, starting February 18, 2020.

Prior thereto or on December 8, 2019, he was hospitalized in a provincial hospital but transferred the following day to an alleged much upgraded hospital and was diagnosed to have suffered Acute Myocardial Infarction. In an effort to save possible recoverable heart muscles, he undergone angioplasty and was prescribed various drugs, one of which is amiodarone, as his myocardial ejection fraction is already below normal.

When no longer in the hospital, he started to have persistent severe coughing starting December 26, 2019, which disturbed his sleep not only once but for several nights. He began to suspect drug-caused coughing but his cardiologist insisted on congestive heart failure, as the cause, despite he was informed that coughing persisted even when seated. His follow-up chest x-ray revealed no pleural effusion but with infiltrates at the right lung.

He was prescribed with an antibiotic but his severe coughing persisted until he was seen by another cardiologist, who recommended re-admission in the hospital because his myocardial ejection fraction was already 31%. He was immediately admitted on January 2, 2020 and treated for pneumonia and several antibiotics were administered. But still, his severe coughing persisted thereafter, which, due to pneumonia and edema or water retention, eventually required re-admission on February 18, 2020.

On re-admission for the second time, his series of chest x-rays perplexed his attending doctors, as it initially revealed clearer lungs more than the subsequent series of results revealing a progressive opacity in the right lung, until it was practically erased, radiologically, just for several days. This was despite of several antibiotics administered.

The attending pulmonologist suspected of a connective tissue problem while the infectious diseases specialist suspected of a fungal infection, with the attending cardiologist being silent, until finally, he was convinced by the author-patient to consider amiodarone lung toxicity as the root cause, and  steroids be administered because the author’s right lung was starting to constrict. Also, the CT-scan result was suggestive of Acute Respiratory Distress Syndrome. He was then put on steriods, with  relief.

Several days before the author was put on steriods, he was given amiodarone twice a day, which did nothing good but caused severe persistent coughing for almost 24 hours. Despite he was given with diphenhydramine, the same failed to put the author to sleep. Hence, amiodarone was discontinued.

In the author’s mind are legal actions against an attending physician, including his possible conspirators, if amiodarone lung toxicity be not considered and steriods, as a last resort drug, be not administered accordingly because truly, it means that the colleague and his conspirators are just bullying the life of the patient. The author was just giving the physician last chance, and he was finally convinced to do so.

On the positive side of the story is the discovery by the author of the preventive and curative importance of steam inhalation therapy in the management of almost all respiratory illnesses due to pollutants, injuries to the lungs and infection. Kudos to the behaviors of an attending physician, without which, the author might not have discovered it.

Left without any other recourse, the author relieved his coughing with steam inhalation therapy, without any doctor’s prior order. And it was successful. It relieved the effect of amiodarone in the mucusal integrity of his right lung. It is because of the blood-tainted substances, which is a sign of trauma due to severe persistent coughing and pink-brownish substances, which is a sign of mucusal tearing, which can cause perpetual coughing to cause the final destruction of the affected lung, that were taken out during the therapy.

It means also that the ciliary movement in the affected mucusa is still intact. Further noted is minimizing and eventually relieving his lungs from inflammation to prevent pulmonary fibrosis. And finally, during his discharge from confinement in the hospital last March 14, 2020, his oximeter readings was restored to a normal level and he is no longer needing supplemental oxygen therapy.

Below are pictures of mucusal fluids mixed with either reddish or pink-brownish substance that were taken during the therapy:

Note the dry cough that the author suffered due to amniodarone toxicity, which was severe persistent non-productive cough that disturbed his sleep and damaged his right lung, is, in moderation, illustrated in the link. https://www.mirror.co.uk/…/what-coronavirus-cough-sound-lik… 

Further, its persistence initially sounded like this:

What is steam inhalation therapy?

Steam inhalation therapy, which is a home remedy for respiratory illnesses using boiled water in a kettle to produce warm water vapor to be inhaled, is used by common folks to aid in clearing the airway to the lungs. Based on the author’s experience however, it even extended up to the clearing of the lungs and throat of offending or cough producing elements, which maybe confirmed to be so, when one is coughing.

In other words, if there is a cough, there is irritant either in the lungs, throat, nasopharynx, including esophagus as in  GERD or Gastro-esphageal Reflux Disease, This is due to the coughing reflex of the human body to expel out unwanted elements as a defense mechanism against invasion.

These irritants include cough producing drugs, e.g, amiodarone, ACE Inhibitors, etc., through their side effects. It is thus not advisable to take cough suppressants, but advisable to get rid of the cause of the irritation to manage coughing.

By purpose, there is an equivalent term for steam inhalation in the surgical parlance. This is debridement, which is a surgeon’s way of getting rid of infected and dead tissues to control infection and facilitate the healing process. However, instead of using scalpel or force to get rid of foreign materials or dead tissues, steam inhalation therapy uses warm or tolerable hot water vapor to be inhaled through the nostril and into the lungs by patient, using moderate to deep breathing, of course, with instruction to exhale later.

Preferably, the lungs and chest cavity be maximally expanded when inhaling. A similar process could be done by sipping in through the mouth, with lung and chest expanded, warm to tolerable hot water vapor to target areas in the nasopharynx and throat, where dead tissues or foreign elements are needed to be expelled or neutralized , as they are causing cough. Notice that the offending virus has predilection to stay in the throat, causing some irritation in the area.

The part of the lungs with irritation or itchyness that causes cough, has to be targetted specifically during the inhalation process to make the area produce mucous. In most cases, this itchy area is sticky or dry and loosening would only happen when enough mucous in the area is produced. The itchy area can also produce wheezes and in most cases, would cause cough while forcefully inhaling but require the process to be continued until enough mucusal fluid is produced to take it out and in order to relieve the coughing.

Sometimes, bearable pain will be felt during inhalation, which is a sign that the offending element has already caused inflammatory reactions, but still the process must be continued until the pain and cough are gone, with focus of inhalation towards it. Repeat the therapy, if needed.

Sometimes,  If the offending element is very deep, you must do the therapy with maximal expansion of the lungs and chest during inhalation and most of the times, it would require your persistence, patience and rest, with intention to continue after sometimes.

For virus or microorganism in the throat, which causes sore throat or irritation in the area and cough, the latter is relieved by way of sipping in through the mouth warm to tolerable hot water vapor, with force,  continuously at least for thirty minutes. Repeat the therapy if cough occurs later.

In the lungs, the mucusal fluid produced while doing the inhalation process serves as lubricant for dead tissues or foreign elements, e.g, virus, to be moved out, aided either by the ciliary movement in the mucusa, internal body pressure or gravitational pull. Without such lubricating effect of the mucusal fluid, it would be very difficult for the irritant to be expelled out, without any effort, at all, or through minimal expectoration. Dry cough may thus result or in some cases, even a forceful cough would only produce a minimal expectorate.

Based on the author’s personal experience, steam inhalation is more potent than any muculytic drug, if done properly. Also, his experience proves that dead tissues, both from the lungs and throat, not to exclude bacteria and virus, can be expelled out, using the above process. It was noted further that coughing or itchiness after an initial relief and after considerable length of time reckoned from the first therapy serves as a warning that there are still remaining unwanted elements or substances, thus, requiring again steam inhalation to relieve coughing or the itchiness.

In other words, the therapy has to repeated until cough or itchiness is permanently gone.

In short, the therapy was observed to have the following effects or properties, to wit: 1) Muculytic effect, 2) Anti-inflammatory effect, 3) Decongestant effect, and 4) based on its property to expel out dead tissues and foreign elements in the lungs and the throat, it has 5) antibacterial and 6) antiviral as well as 7) anti-fungal effect by way expelling them out from the throat and the lungs.

Finally, the behavior of COVID-19 incidentally strongly exposes the strength and potency of the therapy, as the virus is known not to survive in a warmer environment, which is being provided by warm and tolerable hot water vapor in the therapy. And regarding the possibility that COVID-19 is dislodged in the esophagus, which could also cause coughing or itchiness in the area, the remedy is regularly drinking warm to tolerable hot water until the cough or itchiness is gone.

Procedure:

1. Boil water in a kettle.
2. If it is already boiling, take out the kettle from the burner and open it.
3. Wait for few seconds until the heat of the water vapor is already bearable then place your mouth and nostril above the water vapor.
4. Inhale the water vapor, if you want to cleanse the lungs, with deep breathing or maximal expansion of the chest and lungs. If itchiness, pain or cough is present while inhaling, continue the process until the itchiness, pain or cough is gone. Sometimes, you need to rest but see to it that you repeat the process, until the itchiness, pain or cough is gone.
5. Cough out, expectorate or expel the phlegm in a secured container containing ethyl alcohol, if there is and dispose it properly.
6. If you want to cleanse the throat or nasophrynx, sip in, forcefully, with deep breathing or maximal expansion of the chest and lungs, the water vapor through the mouth. Repeat if itchiness, pain or cough persists until it is gone.
7. Cough out, expectorate or expel the phlegm in a secured container containing ethyl alcohol, if there is and dispose it properly.
8. Observe the cough, itchiness or pain if it recurs. If positive, then repeat the therapy.

NOTE: The basis of repeating the therapy, which is manifested by cough, itchiness or bearable pain during inhaling or forceful sipping in of water vapor into the lungs or throat, respectively, is the presence of the offending microorganism or elements.

What to do?

Accordingly therefore, the health program of World Health Organization (WHO)  and different countries involving the virus have to be reviewed and looked into to better manage the COVID-19 pandemic. The recommendations, based on the coughing reflex dynamics in a human body, are as follows:

A. BEWARE OF THE FIRST SIGN OR INDICATION OF VIRUS INVASION AND ACT ON IT IMMEDIATELY

Beware of signs that the virus have entered your nasal cavity, nasopharynx or in already in your throat or lungs or esophagus. The first sign is  sneezing, running nose or coughing or some form of irritation or itchiness in that part of the body. Awareness in this stage is vital. If above signs are present, do the steam inhalation therapy right away. The goal is to stop the virus from multiplying in your body. You must do the therapy once until the coughing, itchiness or the irritation is relieved. Repeat if irritation or coughing, itchiness and/or sneezing develops later.

B. DO NOT EXCLUDE POSSIBLE OTHER CAUSES OF SNEEZING OR COUGHING

Even if you know that your sneezing or coughing is secondary to other causes , e.g, cigarette smoking , etc, do the therapy at once until coughing is relieved. Repeat if coughing, itchiness and/or sneezing develops later. You can relax this advise, if there is no ongoing pandemic.

C. STAGE WHEN ALREADY WITH FEVER ASIDE FROM COUGH AND RESPIRATORY TRACT IRRITATION

This stage means that the virus had already multiplied, with enough numbers, to cause the human body to respond using its defense system, manifested other than by sneezing, running nose, itchiness or coughing. At this stage, it is URGENTLY ADVISED to do the therapy with the goal of eliminating/killing the virus in the respiratory tract, the success of which is when fever is relieved . Do not take any medication for fever, unless there are other reasons for taking it,  just to monitor the success of the therapy. Also, the tendency of the virus to be dislodged in the esophagus, which is also causing cough, has to be managed by regularly drinking warm to tolerable hot water.

D. ADVICE TO THE ELDERLIES AND THOSE WITH EXISTING DEBILITATING DISEASE ESPECIALLY THOSE WITH CARDIAC AND PULMONARY ILLNESS AND DIABETES, CONTROLLED OR OTHERWISE OR IN QUESTION OF THEIR HEALTH STATUS

You must improve as much as possible the function of your lungs by clearing them out of offending elements, clearing the obstruction in the airway to the lungs or improving their present physical limitations through steam inhalation therapy, using deep breathing exercise while inhaling warm water vapor. The lungs and the chest should be maximally expanded while inhaling. The goal is to revive the un-utilized capacity of the lungs to function or reactivating it.This is to enhance the resistance of the body to viral invasion.

E. OTHER PREVENTIVE RECOMMENDATIONS

.1. Those under quarantine, Persons Under Investigations (PUIs), Persons Under Monitoring (PUMs) and any suspected person must not be waited to be positive or show signs and symptoms of the disease but already instructed to do steam inhalation therapy at least once for thirty minutes. The goal is to clear their respiratory tract and reduce their fear and anxiety.

2. Those who are at risk of exposure to cases, including those who are in doubt of their exposure, may also do the therapy at least once at home, after possible exposure, e.g in the market, malls, etc.. The goal is the same with no. 1 above.

3. Doctors and health workers attending to cases may also do the therapy at least once a day or if cough, running nose and/or sneezing ensue, they must immediately do the therapy until cough is gone. Repeat the therapy if coughing and/or sneezing develops later.

4. Medical staff and allies should incorporate in their respiratory communicable diseases treatment protocol the therapy.

5. Lastly, those scared of COVID-19 may likewise do the therapy to prevent them dying from other causes, e.g, heart attack.

The over-all goal of the above is prevention of occurrence of a full-blown disease, and finally,

F. IF ALREADY CONFINED IN THE HOSPITAL

Usually, those who will require confinement at the hospital are with concomitant existing illnesses other than viral infection, including elderlies. It is because their body defense system is already less than normal. In this case, assistive steam inhalation therapy will apply, if the patient can not assist himself to do it. At this stage, the lungs may have been constricting due to inflammation which  would require steriods to open up the alveolis, and worst, may require intubation. In the author’s case, the controversy of giving steriods with alleged co-existing pneumonia condition was settled, with success, in favor of giving steriods with precaution due to diabetes also, that is-it was monitored, with insulin appropriately administered also, but without discontinuing antibiotics. In COVID-19 infection, the cause of constriction of the lungs, and eventually pulmonary fibrosis may not be directly due to virus but due to mucusal trauma caused by dry coughing and consequential inflammation, just like what happened when the author was given amiodarone. Oxygen supplemental therapy and muculytic drug has to be given. Tubal intubation must be done with precaution as the procedure may further cause inflammation due to trauma.  Once the patient is conscious and able to do so, the therapy should be started, with a goal of eliminating the virus, and manage possible bacterial pneumonia, acquired either in the hospital or community, which may co-exist, and other injuries in the lungs.

Imagine, if steam inhalation therapy was able to prevent hospitalization of majority of possible patients, how much savings will be realized by concerned government. Also, the unnecessary sacrifice of doctors dying on their tour of duty and health workers risking their lives to attend to patients could have been prevented.

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About the author:

The author is both a doctor of medicine and a lawyer.  He finished his medical degree at Southwestern University-Matias H. Aznar Memorial College of Medicine (SWU-MHAMCM), Cebu City and placed 5th in the February 1990 medical board examination.

He was President of SWU Supreme Student Government from 1984-1988 and awarded as one of the Top Ten National Student Leaders for 1985 by the Philippine Asean Youth Leadership Educational Foundation (PAYLEF) and the Ministry of Education, Culture and Sports (MECS).  From his preparatory medicine course to medicine proper, he was a national state scholar under the MECS program.  He had his master’s degree in Hospital Administration at UP-College of Public Health, Manila, in 1994 and passed the 2000 bar examination after finishing his law degree on the same year.

He was co-chairman of the Regional Management and Health Workers Consultative Council (RMHCC) in Bicol. The Council was responsible for resolving some issues on Magna Carta benefits for public health workers in the region.

At present, he is the Chief of Regulation, Licensing and Enforcement Division (RLED) at Department of Health-Center for Health Development 5, Legazpi City.

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