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The Sunday TimesPlus

6th April 1997



Your Health

Chronic bronchitis

The silent invader

by Dr. Sanjeewa Wijesinha

Bronchitis is a common enough term - but what exactly does it mean?

In medical terms, chronic bronchitis means a long-standing inflammation of the bronchi - the air passages of the lungs which carry the air we breathe - which is caused by repeated irritation of these vital tubes. Various irritants can be responsible; the commonest of these is cigarette smoke, while people who work in dusty atmospheres are also at risk because they are constantly inhaling these irritants into their lungs. Repeated irritation thickens the delicate lining of the air tubes and damages them - which results in the formation of large amounts of mucus as well as narrowing of the tubes.

The main symptom of bronchitis is morning cough with sputum (phlegm). Some smokers are under the impression that this is a normal "smoker’s cough" - but there is nothing ‘normal’ about it. At first the bronchitis gets worse with a severe cold or the flu, but eventually it reaches a stage when even a mild cold can bring on a nasty flare-up. As time goes on, the production of phlegm and the coughing increase; later on, breathlessness and wheezing become evident. If a person becomes severely breathless when he exerts himself, this is a sign of significant lung damage.

The problem with chronic bronchitis is that once it becomes established, a vicious cycle is set up so that infections occur with increasing frequency and severity, with progressive destruction of the lungs as an inevitable consequence. The end result is severe, permanent lung damage and then, as the heart struggles to pump blood through the fibrosed lungs, heart failure.

The treatment of chronic bronchitis hinges on prevention - prevention of the initial insults inflicted on the lung as well as prevention of destructive infections.

If you smoke, you should stop. This is the vital first step, as it will stop further damage, and with luck the lungs may return to normal. Avoiding smoke-filled rooms is also important.

If you work in a polluted or dusty atmosphere, you should ideally change your work environment - or if this is impossible, change your job. A warm dry climate is better than a cold, damp place as it makes one less susceptible to colds and the flu.

Avoid close contact with folk having colds, since catching any respiratory viruses will trigger off the lung infection. Taking high doses of vitamin C helps, as does the wise use of antibiotics. In some people with bronchitis, it may be necessary to take a small daily dose of preventive antibiotic to protect oneself against bacterial infection. In most bronchitics, taking a full dose of antibiotics at the first sign of respiratory infection will be sufficient prophylaxis.

If you notice that the colour of your phlegm changes to a yellow or green colour, you should see your doctor.

Breathlessness and wheezing can be helped by the use of an aerosol inhaler, while physiotherapy can help if you have difficulty coughing up your phlegm.

The danger with chronic bronchitis is that it starts so quietly that many people do not realise that they have it.

So if you have been constantly exposing your lungs to irritants, and get up in the mornings with a phlegmy cough - beware!

You may well be having chronic bronchitis, and the sooner you see your doctor to get it sorted out, the better.

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