Pulmonary Tuberculosis
This X-ray shows extensive Pneumonia due to tuberculosis, a disease which is still present today.
There are about 10-12 new cases diagnosed each year in the Dearne Valley
and between 20 and 30 new cases in Doncaster
Chest Diseases
Diseases of the chest are common in South Yorkshire because of the mining background and the prevalence of cigarette smoking in this community. More patients consult their GP for chest problems than for any other group of diseases.
In 1992 lung diseases. including lung cancer, accounted for 1 in 6 of all deaths.
Asthma
Asthma is a chronic condition in which inflammation of the airways causes the symptoms of cough, wheeze and shortness of breath.The lives of millions of people are disrupted by these symptoms and even now nearly 1600 people die each year.
It is the most common long term illness in children and young adults, and costs the health service an increasing amount of money. In 1994 asthma prescription alone cost the health service £381 million - 10% of the total NHS spending on drugs.
In the UK it affects between 10 and 20% children and between 5 and 10% adults.
Although effective treatment is available for most patients, there are still problems with patients understanding that prevention of symptoms means that drugs, usually inhaled, need to be taken every day even when they are feeling well.
Inhaled steroids including beclomethasone, budesonide and fluticasone are the main drugs used as preventers.They are safe and effective drugs and the term STEROID should not frighten patients.
Relievers are drugs that work quickly to open the airways and stop wheezing and breathlessness. If the preventer drugs are working well then patients should be able to keep their relievers inhalers in their pockets or bags.
There are many devices used to deliver these drugs to the airways and all have advantages and disadvantages for individual patients. The commonest device is the Metered Dose Inhaler {MDI} which contains a propellant to deliver the drug. These propellant have contained CFC's and are being changed to non cfc propellants to comply with the Montreal protocol. This is an international agreement to stop the use of CFC's in medical as well as non-medical applications as soon as possible. The new inhalers will be introduced slowly and in Doncaster we hope to use this change to optimize patients treatment and reduce the burden of symptoms which many patients just accept as normal because of their condition.
Chronic Obstructive Pulmonary Disease
What is COPD?
Chronic obstructive pulmonary disease is a common condition in which damage over a long period of time leads to breathlessness due to impairment of flow of air in and out of the lungs.
Two related processes chronic bronchitis and emphysema cause COPD. They are both usually due to cigarette smoking although it is recognised that exposure to inhaled irritants such as coal dust can contribute to these conditions.
Whether air pollution is a factor is currently being investigated, although it seems unlikely to be a cause of lung disease but rather a factor which makes pre-existing disease worse.
Chronic bronchitis is characterised by daily cough and production of sputum, where as emphysema is due to progressive destruction of the air sacs (alveoli) leading to reduced ability of the lungs to exchange gases like oxygen and carbon dioxide.This causes severe breathlessness particularly on exertion.
Treatment
There is no cure for COPD but a lot can be done to alleviate symptoms. Firstly an attempt should be made to STOP smoking as without this the condition will worsen and other advice will be of little use.
The principles of treatment are simple:
1. Encourage expectoration i.e. cough up the Phelgm.
2. Treat infections with appropriate antibiotics. Culture sputum if possible. This not only identifies the bacterium but also the antibiotic sensitivity.
3. Prevent infection such as Influenza i.e. vaccinate in the Autumn.
4. Use drug therapy to make the airways wider (bronchodilatation). Use inhaled drugs where possible often in large doses via Spacer devices or nebulisers.
Oxygen Therapy
Oxygen is of use in two situations.
Some people with COPD have low levels of oxygen in their blood. Home oxygen can be beneficial but this treatment must be supervised by a Hospital Specialist. Oxygen is usually prescribed for 15 hours in every 24hrs usually at night i.e. 6pm until 9am. It is delivered by a machine called an oxygen concentrator.This is electrically operated and it extracts oxygen from room air. Patients breathe the oxygen via nasal cannulae (soft plastic tubes which fit inside the nostrils).
Patients with emphysema can safely use oxygen on an as required basis, provided they have been advised that this is safe by a Hospital Specialist. They often benefit from oxygen before exercise.
Bronchiectasis
This chronic condition is characterised by the production of large volumes of sputum. Doctors often ask patients if they cough up more than "an eggcupfull" or more than a "cupfull" of sputum a day. Although patients often present with this condition as adults, it is usually due caused by "coughing illnesses" in childhood. The most common childhood illness which caused bronchiectasis was Whooping Cough. This has been largely abolished because of vaccination.
Treatment
This includes physiotherapy to aid expectoration of the sputum, and antibiotic prescribing to cut down infection and prevent worsening of the condition. In situations where the disease is localised to part of one lung i.e. a single lobe, it may be possible to remove sugically the diseased tissue. This is known as a Lobectomy. It may result in considerable improvement in symptoms.
Further information about other lung diseases including pulmonary fibrosis and occupational lung disease will be placed here soon. This should include advice regarding compensation for ex Coal Miners who have Bronchitis and Emphysema, and information about Asbestos and its long term affects on the lungs. Former coal miners with diagnosed chronic Bronchitis and emphysema can claim a pension from the DSS if they have worked 20 years under ground and have a reduction in their lung volumes by nore than 1 litre compared to the predicted for their age and height.
Dr David N Cooper MB FRCP
Last updated 17th August 2003
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