Nepal National Hospital, which specialises in pulmonary treatment, also offers multispecialty care

A few months ago, Sunita Banjade (50), experienced shortness of breath and wheezing. Banjade had been suffering from chest pain and fatigue for a while, and she had also had a severe cough for over a year. However, she had ignored these symptoms until she blacked out while wheezing in her kitchen. Her son found her unconscious and rushed her to Nepal National Hospital in Kalanki. Upon examination, Dr Prakash Poudyal, Consultant Physician/Pulmonologist and Medical Director of Nepal National Hospital, discovered that Banjade had developed asthma due to prolonged exposure to outdoor air pollution.
Dr Poudyal's team found that pollutants present in the air, such as particulate matter, nitrogen oxides, and sulfur dioxide, had caused inflammation in Banjade's airways, leading to the symptoms she experienced. The diagnosis was confirmed through pulmonary function tests, which revealed reduced lung capacity and impaired gas exchange. “The cases of pulmonary-related issues have been growing tremendously among Nepali people. Tuberculosis (TB), pneumonia, and lung cancer are some of the major pulmonary issues affecting the Nepali population,” he added. 
According to Dr Poudyal, the major causes of pulmonary issues in Nepal include indoor air pollution from the use of biomass fuels for cooking and heating, outdoor air pollution, smoking, and occupational exposure. These risk factors can lead to chronic obstructive pulmonary disease (COPD), asthma, and other respiratory conditions, he added.
Nepal has one of the highest rates of indoor air pollution globally, primarily due to the widespread use of biomass fuels like wood and animal dung for cooking and heating purposes. This has resulted in an increased risk of respiratory infections, chronic obstructive pulmonary disease (COPD), and lung cancer.
Moreover, major cities in Nepal, including Kathmandu, suffer from high levels of outdoor air pollution caused by vehicular emissions, industrial pollution, and open burning of waste. These pollutants can cause respiratory problems such as asthma, bronchitis, and COPD, he added.
In recent years, the government has taken some initiatives to address the issues related to indoor air pollution, such as implementing the National Clean Cookstove Programme to reduce indoor air pollution and develop air quality monitoring systems in major cities. However, Dr Poudyal said much more needs to be done to improve respiratory health in Nepal, particularly in terms of reducing exposure to air pollution and promoting smoking cessation. He described pulmonary diseases as a broad category of medical conditions that affect the respiratory system, including the lungs, trachea, bronchi, and other structures.
Dr. Prakash explains that the causes of pulmonary diseases can vary depending on the specific condition, but smoking, environmental factors, infections, genetic factors, occupational exposure, allergies, and ageing have been identified as leading causes of such issues.
Smoking remains the leading cause of lung cancer, chronic obstructive pulmonary disease (COPD), and other lung diseases. Exposure to air pollution, secondhand smoke, and other environmental pollutants can also contribute to the development of lung disease.
Moreover, respiratory infections caused by bacteria, viruses, and fungi can damage the lungs and lead to pulmonary disease, he added.
According to Dr Poudyal, certain genetic mutations can increase the risk of developing diseases such as cystic fibrosis which is a genetic disorder that affects the lungs and other organs. As people age, their lung function may decline, making them more susceptible to respiratory problems, he said. “However, it is important to note that many pulmonary diseases have multiple causes, and often a combination of factors can contribute to their development,” he added.
Moreover, the severity and impact of these issues on an individual can vary depending on several factors, such as the type of condition, its severity, the individual's age, overall health status, and the presence of any other medical conditions.
The cases of pulmonary diseases have been rising at an alarming rate in recent times due to the high levels of pollution, especially in Kathmandu, which is often ranked as the most polluted city in the world. 
The healthcare infrastructure in Nepal faces some challenges in terms of access and resources. Nepal has a high burden of pulmonary diseases, including chronic obstructive pulmonary disease (COPD), asthma, and tuberculosis (TB). According to the World Health Organization, Nepal has one of the highest TB incidence rates in the world.
In terms of equipment and resources, many healthcare facilities in Nepal lack advanced diagnostic tools and treatments. Access to high-quality medical care is also limited in rural and remote areas, where many people do not have access to healthcare facilities or providers. Likewise, the level of equipment and resources available for treating pulmonary issues in Nepal varies depending on the region and healthcare facility.
However, there have been efforts to improve the healthcare infrastructure in Nepal, particularly in the areas of TB and respiratory health. The government has implemented a national program for TB control, which includes the expansion of diagnostic services and the provision of free TB treatment. The program has helped to increase access to TB care and reduce mortality rates.
In addition, international organisations and non-governmental organisations (NGOs) have supported the development of respiratory care services in Nepal. For example, the Nepal Asthma Foundation, a local NGO, has provided asthma education and awareness programs, as well as free asthma medication for low-income patients. Overall, while the healthcare infrastructure in Nepal may face challenges in terms of access and resources, there have been efforts to improve pulmonary care services, particularly in the areas of TB and respiratory health.
Nepal National Hospital, which specialises in pulmonary treatment, currently offers diverse categories of services related to it. It has facilities like lab investigations, chest x-ray, ultrasound, ultrasound-guided diagnostic and therapeutic procedures, Pulmonary Function Test (PFT), ECG, ECHO, Bi-PAP, CPAP, high flow nasal cannula (HFNC), Ventilator services along with ICU, negative pressure ICU, isolation ICU, chest physiotherapy and pulmonary rehabilitation, according to Dr Poudyal. 
“We are dealing with several pulmonology-related cases daily. So our team is solely sensitised to prompt handling, early diagnosis and proper management of the case following standard protocols and safety measures,” he added. Likewise, the hospital team collects feedback from the patients which shows that the treatment comes from a reasonable budget.
According to doctors, it is crucial to manage and treat pulmonary issues appropriately. Early diagnosis and treatment can prevent complications and improve an individual's overall health and quality of life. However, they also said that it is essential to maintain a healthy lifestyle, quit smoking, and avoid exposure to environmental irritants that can worsen pulmonary conditions.
“It is important to speak with a healthcare provider to assess individual risk factors and take appropriate preventive measures,” Dr Poudyal added. Talking about the role of the new economy, he said the new economy can transform Nepal's medical industry by improving access, and efficiency, and reducing costs through telemedicine, digital records, AI, and collaboration among healthcare providers, researchers, and patients. 
“It can facilitate telemedicine and teleconsultation services, which can improve access to medical care for people in remote areas or those who cannot travel to a healthcare facility,” Dr Poudyal said, adding that digitisation of medical records, appointment booking, and billing can increase efficiency in the healthcare system.
Though the new economy has the potential to transform the medical industry in Nepal, there are both benefits and disadvantages to consider. Nepal's healthcare also has limitations as the infrastructure is not equipped to handle the demands of the new economy, as many healthcare facilities may not have access to the necessary digital technologies. Likewise, low internet penetration can limit the ability of patients and healthcare providers to access digital healthcare services.
“The digitisation of medical records and other sensitive information may raise privacy and security concerns, particularly in a country like Nepal with limited data protection regulations,” Dr Poudyal.
To fully realise the potential of the new economy in healthcare, Nepal will need to address infrastructure and technological literacy issues, as well as privacy and security concerns, he added.