I used to smoke 30 a day (though I haven’t touched a cigarette for 14 years). This led to COPD and it’s getting worse.
I’m on several inhalers and pills to remove phlegm, and eight cylinders of oxygen a fortnight.
I get in a panic when I stress myself in any task. Is there any progress being made to relieve the effects of COPD?
– Terry Duncan, Bridlington, East Yorkshire
COPD, or chronic obstructive pulmonary disease, is an umbrella term for what were previously referred to as chronic bronchitis and emphysema, and is often caused by smoking
COPD, or chronic obstructive pulmonary disease, is an umbrella term for what were previously referred to as chronic bronchitis and emphysema.
These separate but commonly co-existing lung conditions both make it difficult to take in enough oxygen.
Bronchitis leads to inflammation of the lining of the airways and increased mucus production. Emphysema is where the alveoli (tiny air sacs in the lungs) are destroyed.
Those with COPD have limited airflow in and out of the lungs and their lung tissues are less able to absorb oxygen into the blood or to pass carbon dioxide out.
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This leads to breathlessness, coughing, mucus production and wheezing.
Though smoking is the main cause, air pollution can also contribute, as can pollution in the home from open fires, cleaning products, fluff and dust.
It’s important you do all you can to ensure you’re in the cleanest possible air.
The aim of treatment is to control symptoms, reduce flare-ups (usually due to infections) and improve your quality of life.
The mainstay are inhalers. These usually involve a combination of three drugs: bronchodilators to ease spasm in the airways; anticholinergics to reduce mucus secretion; and glucocorticoids (steroids) to reduce inflammation.
Pulmonary rehabilitation (exercise programmes that train you to breathe better) also has a major role, as does oxygen therapy, which you are already using.
Illustration of healthy human lungs. Those with COPD have limited airflow in and out of the lungs and their lung tissues are less able to absorb oxygen into the blood
This is recommended for patients with low blood oxygen levels when at rest or those in whom oxygen levels drop when merely walking.
Long-term oxygen therapy improves survival and quality of life, and it may be that you are eligible for an oxygen concentrator (a machine that concentrates oxygen from the air) rather than having to receive regular deliveries of cylinders. Ask your GP.
Write to Dr Scurr
To contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email [email protected] – including contact details.
Dr Scurr cannot enter into personal correspondence. His replies cannot apply to individual cases and should be taken in a general context. Always consult your own GP with any health worries.
Recently a group of drugs called PDE-4 inhibitors have come to the fore in the treatment of COPD (PDE-4 are enzymes found in the cells of the immune system).
These reduce inflammation in ways that steroids do not and may also help relax the muscle in airway walls.
One example is roflumilulast, but it has to be prescribed by a chest physician and, according to guidelines, should be given only as part of a clinical trial.
Another option is lung volume reduction surgery. In some patients, the loss of alveoli may lead to large bubbles in the lungs called bullae, which trap air.
These can make it hard for air to get in and out of the alveoli that are still functioning.
Removing these bubbles allows the healthier parts of the lungs to function better.
This is major surgery, but it is worth asking your chest physician if you might be suitable.
My son, aged 19, has gynaecomastia.
His doctor said it will go away, but he’s very conscious of it and it’s preventing him from going to university until it’s rectified.
He insists the only operation he can have without leaving scarring (through the nipples) is available just in India.
We’re worried and want him to be treated here, which we will pay for. Can you advise?
Name and address supplied.
Gynaecomastia, or male breast enlargement (some people refer to them as moobs), is so common in teenage boys
Gynaecomastia, or male breast enlargement (some people refer to them as moobs), is so common in teenage boys it can almost be considered a normal part of their development — it affects about half of them to some extent.
It occurs because of fluctuations in hormones, both male and female, that boys experience in puberty — this causes the glandular tissue to enlarge.
The ‘swelling’ reduces once this hormonal flux settles down between the ages of 18 and 22.
Even so, it can be psychologically distressing for some people, and your son is no exception.
The emotional turmoil and self-consciousness he is experiencing is clearly such that, despite the reassurance from his doctor that the condition will improve in time, he is determined to have surgery. I suggest a two-fold approach.
Have a candid discussion with him about the need to confront his anxiety and try to persuade him to seek referral to a psychologist, through his GP, to help him come to terms with his feelings.
Gynaecomastia can be psychologically distressing for some people, but is reduced once the hormonal flux settles down between the ages of 18 and 22
Dissuade him from travelling abroad for treatment. One reason is that it is difficult to be completely certain that the surgical care in another country, whether India or elsewhere, is safe.
Another issue is that — as with any surgery — there may be some post-operative complications, such as infection. It will be harder for him to manage these if he has travelled home.
It is possible to have a minimally invasive operation for the condition in the UK, whereby excess tissue is removed via an incision in the nipple.
WHAT IS GYNAECOMASTIA?
Gynaecomastia (sometimes referred to as ‘man boobs’) is a common condition that causes boys’ and men’s breasts to swell and become larger than normal.
It is most common in teenage boys and older men.
Signs vary from a small amount of extra tissue around the nipples to more prominent breasts.
It can affect one or both breasts.
Sometimes, the breast tissue can be tender or painful, but this isn’t always the case.
Source: NHS Choices
The procedure involves liposuction, where the tissue is sucked out using a small tube.
This is not available on the NHS as it is considered to be cosmetic/aesthetic surgery, and is non-essential — such procedures are very much rationed in these straitened times.
However, you have signalled your willingness to support the procedure financially.
To ensure you see a plastic surgeon with the necessary expertise, I suggest you go to the website of the British Association of Aesthetic Plastic Surgeons and look for a recommended specialist in your region.
The website has a section on gynaecomastia and describes the procedure in more detail, specifically noting a 3mm to 4mm scar at the nipple.
You will not find a technique elsewhere that leaves a smaller scar than this.
Do not accept the services of a surgeon who is not a member of this organisation.
And even if your son does plan to go ahead in this way, it would still be wise for him to have at least one or two sessions with a psychologist.