Chronic cough

IF SYMPTOMS PERSIST

By DR. JOSE PUJALTE JR.

“Quitting smoking is easy,  I’ve done it thousands of times.”

— Mark Twain (1835-1910), U.S. satirist

Dr. Jose Pujalte Jr.

I’d like to meet people who enjoy coughing as much as smoking. It’s probably easier to explain “smoker’s cough” or emphysema to them. Smoking is not the sole cause of emphysema but since 80% of cases are mostly chronic smokers, the association sticks. Emphysema is also part of a group of diseases that insidiously damages the lungs.

Collectively, chronic bronchitis, obstructive bronchitis, and emphysema are called COPD or chronic obstructive pulmonary disease. The final common pathway is destruction of the lungs’ air sacs or alveoli. The damage is thought to be caused by the toxic substances of cigarette smoke. However, you can also develop emphysema from second-hand smoke. Sometimes, the risk comes from work – from fumes, chemicals, or products that produce inhalable dust from cotton, grain, and wood.

Signs & Symptoms. The effects of smoking on the lungs and their network of tubes (the bronchi) take time because of the tremendous capability of the body to sweep out debris. Microscopic hairs or cilia normally ferret out irritants but over time, these too are damaged and the poisons remain. Eventually, the elasticity of air sacs needed in the exchange of air is lost. Not all the air is completely forced out in the cycle of breathing. Soon, taking in air and expelling carbon dioxide becomes a huge effort. This description is in fact:

• Dyspnea or shortness of breath. In time, there’s even difficulty in breathing when lying down but especially when there are colds; emphysema can also present with persistent cough with phlegm.
• Chronic tiredness because the body has less oxygen to use.
• Weight loss and lack of appetite – an indirect result of difficulty of breathing while eating.

Diagnosis. The doctor to see is the family medicine practitioner or the pulmonary medicine specialist (pulmonologist ). After a physical exam and chest xray,  PFTs or pulmonary function tests may also be in order. This involves blowing into a tube called a spirometer. It  measures the amount of gas exchanged in the lungs. ABG or arterial blood gases analysis measures how efficiently oxygen is carried into, and carbon dioxide taken out of, the blood. Sputum may be examined for chronic infections.

Treatment. The first step in treatment is ridding one’s self of the very reason for emphysema -- smoking! The risk for smokers developing emphysema is ten times that of non-smokers. Antibiotics treat any concomitant infection. Constricted airways that make breathing an ordeal can be lessened with bronchodilators. Aerosol steroids are given to emphysematous patients with asthma or bronchitis. Thoracic surgeons may be called in for a salvage procedure where damaged sections are removed to make the remaining healthy lung tissues more effective. It is called LVRS or lung volume reduction surgery, a sort of liposuction for the lungs.

At the end of the day, we bring unto ourselves retribution for the sins of excess.

Emphysema is just a morality play on inhaling smoke now and consequently suffering for it later. How one figures – as a hero or victim – is really a matter of choice.

Dr. Pujalte is an orthopedic surgeon. email[email protected]