Respiratory
Health: The Warning Triad
S.K. Jindal,
MD (Medicine), FAMS,
FCCP, FNCCP
(Former Professor
& Head, Department of Pulmonary Medicine,
PGIMER, Chandigarh, India)
Medical Director
Jindal Clinics, SCO
21, Sector 20 D, Chandigarh, India 160020
The
symptoms of cough, sputum and breathlessness, either alone or in combinations
are almost “normally” present in milder forms.
It is not uncommon for a healthy individual to cough and even produce
some degree of sputum on a winter morning.
All of us also get breathless on exertion when an unaccustomed activity
is performed. One generally tends to
ignore these symptoms attributing their origin to a seasonal change, inhalation
of dust and smoke; old age or cold exposure.
But these symptoms may reflect the status of the respiratory health –
normal or abnormal.
Cough
of common cold is of short duration and often accompanied with symptoms of
coryza such as malaise, fever, sneezing and running nose. It is usually of viral aetiology and needs no
specific treatment.
When
accompanied with sputum production (expectoration), cough is said to be
productive while small quantities of sputum may arise from hyper-secretion of
mucous glands, large, thick or tenacious sputum is more serious. This may follow an episode of severe
pneumonia or other lung infections.
Formation of a cavity or a lung abscess is a common sequala of a poorly
or inappropriately treated lung infection.
A severe childhood infection can damage the airways and become a chronic
source of cough and expectoration – a condition known as bronchiectasis. Tuberculosis is an important cause of
unrelieved cough persisting for several weeks.
But all cough is not tuberculosis and also tuberculosis may not manifest
with cough.
Tobacco
smoke is one of the most important cause of chronic cough. It induces cough by both irritant and
chemical actions. Smokers’ cough is a
nuisance symptom. It is common to see a
smoker inhaling smoke and coughing repeatedly.
In
fact both the smoker and those in his close company get so habituated to the
noise that it is unnoticed and denied.
Chronic cough may indicate the presence of chronic bronchitis (chronic
inflammation of the airways) and emphysema which are about 10 to 20 times more
often seen in smokers. Collectively
called as chronic obstructive lung disease, it is an important cause of chronic
respiratory disability, failure and death.
Another
mechanisms of smoking causing coughing is even more ominous. It is the lung cancer which occurs in
smokers, more than 20 times more often than nonsmokers. Any aggravation as change in behaviour of
cough in a smoker should always alarm the patient, as well as the doctor about
the possibility of a complication.
Patients
with bronchial asthma may also complain of cough with or without breathlessness
and wheezing. This shall obviously not
respond to treatment with cough sedatives and expectorants unless
anti-asthmatic drugs are also instituted.
Asthma
remains an important cause of episodic breathlessness throughout life. In middle aged and old people however attacks
of breathlessness can occur in the presence of heart failure or other serious
problems. The subject is obviously more
ill in such a condition. Chronic
obstructive lung disease is another common problem which causes difficulty in
breathing in adults. It is 20 to 40
times more common in smokers. Often
ignored in the beginning, it gradually progresses and leads to early
respiratory disability and failure. In
latter stages it makes the person a respiratory cripple who is constantly
gasping for breaths. Most other diffuse
lung diseases also advance similarly. In
fact it presents one of those helpless situations for a doctor wherever
palliation cannot be offered. There is
no way to slow down the fast respiration which every moment may seem to end.
Breathlessness
need not be associated with serious illnesses even if it be chronic. Simple obesity is an important cause. Breathlessness of obesity is akin to that of
a person with an optimum weight carrying an extra load of a person with an
optimum weight carrying an extra load all the time. Besides posing limitation on activities, it
does lead to serious health problems after some years. Marked obesity is a recognized cause of
respiratory failure which again, is preventable and partially reversible.
Breathlessness
may also occur due to deficiency of blood in conditions of anaemia. Improvement of haemoglobin will therefore be
associated with relief from dyspnoea.
In
the absence of an organic illness, breathlessness may occur in highly anxious
and tend individuals. Getting out of
breath during an acute anxiety is experienced by every individual. But it may manifest as a symptom of hidden
anxiety. Some hysterical individuals,
especially children, are known to develop episodes of fast and apparently
laboured respiration. Like most other
hysterical phenomenon this is generally meant to achieve a secondary gain and
relatively easily handled.
It is
a common misconception that all types of breathing difficulties are potentially
treatable by exercise. It is a tricky
situation. Exercise, no doubt, is of
paramount importance for a healthy, sedentary or obese individual who needs to
increase his breathing capacity. On the
other hand, any undue exertion for a person with an underlying cardiac or lung
disease should be undertaken only under caution. It may not over burden the
already strained system. Even the
breathing exercises may compromise the lung function and aggravate the problem.
Treatment
of any or all of these symptoms depends upon the underlying cause. Their presence need not cause panic but
persistence should certainly signal the need to seek medical attention.
Dr S.K. Jindal,
Prof. & Head,
Dept. of Pulmonary Medicine,
PGIMER, Chandigarh.
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