Chronic obstructive airways disease - the sufferer is nearly always short of breath

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This causes chronic breathing problems with occasional flares.

It usually results from a combination of factors:

  • Chronic asthma for which the cause has never been found and excluded.
  • Chronic infection: such as bronchitis or bronchiectesis.
  • Chronic lung inflammation: from pollution.
  • Emphysema: this is secondary to chronic inflammation. The normal lung is made up of millions of tiny bubbles (alveoli) which create a large surface area which, if laid flat, would be the size of a tennis court. This allows oxygen to diffuse into the blood stream. With emphysema the walls between these bubbles are destroyed and this reduces the total surface area for oxygen to diffuse.

Fluid on the lungs is often a complicating factor if the sufferer also has heart failure.

Common causes of COAD

  • Smoking is the major cause.
  • Occupational exposure to dusts: coal miners and pneumoconiosis is the major cause in UK, but any dust can cause problems.
  • Pollution from industrial discharges - this is becoming a more common cause than smoking.
  • Chronic allergy - consider foods (see Stone Age Diet - this is a diet which we all should follow ), inhalants, (pollen, dust, animal or bird dander) eg bird fanciers lung.
  • Chemicals - (see Multiple Chemical Sensitivity (MCS) - Principles of Treatment and the other linked articles on that page).
  • Micro-organisms - (moulds, atmosphere eg farmer's lung, bacteria in the gut).
  • Chronic infection: smoking, untreated pneumonia causing bronchiectesis, TB.
  • Pulmonary fibrosis:rare and very difficult to manage. Specialist help needed.

Treatment

Identify the cause and eliminate where possible. See Nutritional supplements and Viral infections.

  • Treat infections early and aggressively with antibiotics and nutritional supplements: I often give my patients a supply of antibiotics to keep at home to take at the first sign of a flare. Sputum samples are useful to see which bug is causing the problem and make sure an appropriate antibiotic is being used.
  • When the cause cannot be found or avoided keep the airways opened up with inhalers: blue ones (bronchodilators).
  • Keep inflammation in the lungs down with brown inhalers (steroids).
  • Steroids by mouth may be necessary to control acute flares.
  • Nebulising is a more efficient way to deliver the drugs if the breathing is so poor the inhalers do not work. I often put magnesium sulphate in the nebuliser to allow smooth muscle to relax.
  • Physio to help get rid of secretions may be helpful. Guaifenesin is often helpful to thin mucous and make it easier to cough up - 400mgs-2,000mgs daily.
  • In severe cases oxygen can be very helpful to treat flares. Some people have to remain on regular oxygen in which case an oxygen concentrator is very useful.
  • Treat associated problems such as heart failure. See Ischaemic Heart Disease - what really causes it?

Medical help is always needed with all of these conditions.

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