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DR MARTIN SCURR: Try Physiotherapy Sessions To Ease Chronic Coughing
DR MARTIN SCURR: Try Physiotherapy Sessions To Ease Chronic Coughing
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Thursday, Apr 22nd 2021 7AM 9°C 10AM 15°C 5-Day Forecast
Published: 01:50 BST, 20 April 2021 | Updated: 01:57 BST, 20 April 2021
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My wife Patricia has many illnesses including asthma, bladder problems, Crohn’s disease, type 2
diabetes and bronchiectasis. The latter condition causes bouts of chesty coughing, but we have
been told there is no cure. I would appreciate any advice.
Bronchiectasis is a chronic, irreversible lung condition, and coping with it must be hard for your
wife — especially in the context of her other health problems. It is typically associated with a
cough, producing sputum that is difficult to shift.
Bronchiectasis occurs as a result of the gradual destruction of the walls of the bronchi (the main
passages to the lungs) and other airways.
This causes the bronchi to widen, and can lead to the lining breaking, bouts of infection and the
patient coughing up blood. The condition may also inflame the airways, obstructing the airflow.
+3
Bronchiectasis occurs as a result of the gradual destruction of the walls of the bronchi (the main
passages to the lungs) and other airways [File photo]
It can have a number of causes, including chronic obstructive pulmonary disease (COPD — an
umbrella term for a group of common lung conditions, including emphysema), rheumatic
disorders such as rheumatoid arthritis, and genetic diseases such as cystic fibrosis.
In the days before widespread immunisation against whooping cough, childhood infection was
also a major cause.
It’s thought that asthma and bronchiectasis are related, because both cause inflammation of the
airways.
If someone has both conditions, asthma may prevent the proper diagnosis of bronchiectasis, as
coughing, breathlessness and sputum production are symptoms of both.
A CT scan of the lungs is used to confirm the diagnosis — this will show changes in the
appearance of the air passages leading to the lungs, including their widening and thickened walls.
+3
It’s thought that asthma and bronchiectasis are related, because both cause inflammation of the
airways. If someone has both conditions, asthma may prevent the proper diagnosis of
bronchiectasis, as coughing, breathlessness and sputum production are symptoms of both
Your wife may have to take antibiotics if there is an infection. Ideally, a sputum sample should
be tested to identify the bacterium responsible and pinpoint the correct antibiotic to treat it.
The mainstay of treatment for bronchiectasis is daily chest physiotherapy. This can help with the
drainage of sputum, and involves sessions with a physiotherapist who can advise on postural
changes that encourage it to be coughed it up.
Once the technique is learned it must be used in long-term regular sessions, once or twice daily.
What will be helpful is for your wife to stick with the chest physiotherapy. The more she can
clear the sputum, the less the continuing inflammation and infection will trouble her. Her GP
should be able to refer her for this treatment.
I’ve had heart palpitations for around three years, which have caused panic attacks. Tests have
shown that everything is fine, but in 2019, after seeing a stressful moment between my husband
and his parents, these attacks became painful. Now, whenever there is an anxious episode these
happen. I am 37.
As you say, the painful thumping heartbeats are triggered by anxiety, and even though rationally
you understand why you feel this way, I would guess this has become an involuntary reflex,
which began when you witnessed the emotional moment you describe.
The reaction is kickstarted by the sympathetic nervous system, which acts largely unconsciously
to regulate many bodily functions such as core temperature.
It also activates the changes needed to ensure survival when threatened. This all starts in the
amygdala of the brain, an area that processes fear and stress responses. It is connected to the
hypothalamus, which activates the pituitary gland, releasing hormones which stimulate the
adrenal glands.
+3
As you say, the painful thumping heartbeats are triggered by anxiety, and even though rationally
you understand why you feel this way, I would guess this has become an involuntary reflex,
which began when you witnessed the emotional moment you describe
This, in turn, triggers the release of cortisol and adrenaline, the stress hormones. These increase
activity in the vagus nerve (which runs from the brain to the colon via many internal organs,
including the lungs and heart), causing the tightness in your throat which you mention in your
longer letter.
The vagus nerve is partially responsible for the increase in heart rate and blood pressure, and,
combined with the adrenaline, this leads to the more prominent heartbeat you experience.
I think you would benefit from a form of talking therapy called cognitive behavioural therapy
(CBT), as this aims to alter the way you react to stress. Your GP can refer you to a clinical
psychologist.
Write to Dr Scurr
Write to Dr Scurr at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email
drmartin@dailymail.co.uk — include your contact details. Dr Scurr cannot enter into personal
correspondence.
Replies should be taken in a general context and always consult your own GP with any health
worries.
Fruit sugar, or fructose, is often found in processed foods, where it is mainly derived from corn
starch.
Through evolution, our intestines have adapted to digest fructose in the quantities obtained from
fruit. However, the larger amounts in commercially processed fruit juices and other foods swamp
the natural mechanisms and are absorbed, moved to the liver and turned into fat.
This is one of the reasons why, in recent years, there has been an ever-rising incidence of non-
alcoholic fatty liver disease, which is now thought to affect one in three adults in the UK.
When severe, it develops into an even more worrying condition, non-alcoholic steatohepatitis.
This can in turn lead to severe scarring of the liver (cirrhosis), and an increased risk of liver
cancer.
This is thought to be because, when it’s digested, chemicals in coffee are converted into
paraxanthine, a compound that slows the growth of scar tissue (seen in cirrhosis).
Two other chemicals in coffee, kahweol and cafestol, may also help prevent liver cancer.
The upshot of this is that it’s time to cut back on the fruit juice and smell the coffee instead.
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