Air Pollution Diseases And Smoking Effects
The symptoms include a sore throat, hoarse voice, dry painful cough and wheezing. In addition, in small children, whose airways are normally narrow, inflammation may lead to dangerous obstruction with the production of a harsh, strident, inspiration noise known as a strider.
Chronic laryngitis which causes persistent hoarseness of the voice for days or weeks may result from excessive use of the voice (speaker's throat), but if it persists for more than three weeks the larynx should be examined to exclude either a carcinoma arising at that site or paralysis of the vocal cords from interference with the nerve supply to the larynx by a growth in the lungs.
Chronic bronchitis is an extremely common disease in the British Isles, also a very serious one as it may be associated with crippling, and at times fatal, complications. Its course may be divided into four stages:
1. Enlargement and over activity of the mucus-secreting glands in the walls of the bronchi
2. Bacterial infection of the mucus
3. The development of emphysema
4. Cardiac and respiratory failure
Stage I. The reason for the sudden production of excessive amounts of thick tenacious mucus is not known. It usually occurs in men over the age of 40, often seeming to follow an acute virus infection of the respiratory tract, and once the condition is established it is aggravated by many factors. Bronchitis is always worse in cold damp winter weather. The irritant effect of fog and industrial smog is particularly harmful but the prevalence of this has been reduced since the creation of smokeless zones following the passing of the Clean Air Act by Parliament in 1956.
The disease is also made worse by exposure to dust, fumes or sudden changes of temperature. In particular the dangerous irritant effect of cigarette smoking cannot he overemphasized. As soon as the diagnosis is made the patient must stop cigarette smoking and avoid all forms of bronchial irritation even if this means changing his job. Mucoid sputum is sticky and difficult to expectorate but this is often made easier by increasing its water content, either by inhalations of steam or by the use of a humidifier. The suppression of an irritant cough at night by a linctus containing codeine is helpful.
Stage 2. Intermittent acute episodes of infection are common. The patient feels toxic, is febrile, the wheezing and shortness of breath become more marked and in addition the sputum increases in amount and changes to a yellow or green colour. The bacteria usually responsible for this type of infection are the Hemophiliacs influenza and pneumonia. The antibiotics tetracycline and penicillin (Pertinent) are equally effective against these organisms. Sometimes a combination of penicillin and streptomycin (Crystalline Forte) is administered by intramuscular injection.
Stage 3. Repeated episodes of bronchitis associated with severe bouts of coughing put a great strain on the tissues of the lungs resulting in the development of emphysema. In this condition the walls of many of the alveolar rupture with the formation of large balloons or bullae while at the same time many of the surrounding capillaries are destroyed; in addition the lung tissue loses its elasticity with resultant difficulty in expelling air from the lungs. After a time the lungs remain in a constantly distended state with the chest assuming the shape of a barrel. These structural changes result in a serious reduction in the amount of oxygen entering the blood and an accumulation of carbon dioxide in the tissues.
Stage 4. When lungs already severely damaged by chronic bronchitis and emphysema are subjected to the added strain of an acute respiratory infection, respiratory failure may develop with a further marked lowering of the oxygen pressure and sharp rise in the carbon dioxide pressure in the blood. The amount of carbon dioxide retained in the blood is so excessive that it has an action similar to a powerful narcotic drug (carbon dioxide narcosis) with drowsiness, disturbance of behavior with agitation at times amounting to violence, rambling delirium, coarse flapping tremor of the hands similar to that seen in liver failure, and marked depression of respiration. This severe disturbance of the blood gases also adversely affects the heart and bl(axl vessels with the development of cardiac failure. Cardiac failure when it arises as a complication of disordered lung function IS sometimes referred to as car Pontianak.
Treatment includes the use of diuretics and the administration of oxygen. It must, however, be clearly understood that as carbon dioxide narcosis has a severe depressive effect on the respiratory centre in the brain the only stimulus to breathing is oxygen lack. If this stimulus is removed by the administration of pure oxygen the patient becomes increasingly drowsy and comatose until finally breathing ceases altogether. In view of this paradox a compromise has to be reached whereby the patient is given a mixture of oxygen and air using a Ventilate which is specially designed to deliver a 30 per cent mixture of oxygen with air. When respiration is markedly depressed the respiratory center can sometimes be artificially stimulated by the use of drugs such as alienation ( Da ptazole) or nikethamide (Coramine). Occasionally a tracheosionly has to be performed and breathing maintained by a respirator.
Bronchial asthma is characterized by episodes of severe spasm of the muscle in the walls of the bronchi. The attacks usually begin in childhood or adolescence but in some people the orisons later. When the disease begins in childhood there is often a history of other members of the family
suffering from either hay fever, urticaria, infantile eczema or a combina¬tion of these. The constriction of the bronchi is produced by an abnormal hypersensitivity or allergic reaction to proteins in the environment. This is called extrinsic asthma. The proteins include ones which are inhaled, such as pollens, moulds, house dust, animal hair, face powder and dandruff: also, but less commonly, proteins in food such as eggs, milk, fish or chocolate. In addition, the bronchi in an allergic subject may go into spasm in response to emotional stress. When the disease starts in middle age there is often no evidence of allergy to external proteins and it is assumed that such a patient must be allergic to his own internal body protein. This is called intrinsic asthma.
An attack of asthma starts suddenly with intense constriction of the bronchi so that within minutes the patient is wheezing loudly and gasping for breath. Cough and sputum do not appear until the attack has been present for some time. There is a wide variation in the frequency and duration of attacks from patient to patient. In between, an asthmatic may often appear to be in good health but frequent severe episodes lead to the development of emphysema, and in children result in loss of weight, stunted growth and deformities of the chest wall.
In asthma, as in other allergic disorders, there is a considerable increase in the number of eosinophil cells in the blood; in addition the sputum often contains solid plugs in which eosinophil cells may be found.
Status asthmaticus is a severe, prolonged, life-threatening attack of asthma requiring prompt, skilled and energetic treatment, Such an attack may be controlled by an intravenous injection of aminophylline but often the violent allergic reaction in the bronchi has to be suppressed by the injection of corticosteroids using either hydro cortisone, intravenously, or intramuscular injections of corticotrophin.
Formerly the routine treatment of asthma. 'included sucking a tablet of isoprenaline sulphate or the subcutaneous injection of a 1 in 1,000 solution of adrenaline, but these methods have been superseded since the introduction of broncho dilator aerosols containing either noradrenaline or adrenaline or orciprenaline (Alupent) or salutation (Ventolin) which are easy to use, readily portable and very efficient as they deliver a measured dose of the substance directly into the respiratory tract. Persistent incapacitating asthma requires the use of oral steroids such as prednisone or the twice or thrice weekly injections of corticosteroid (ACTH).
It is essential to try to prevent future attacks.
The recent introduction of disoditun cromoglycate (Inuit), a substance which when regularly inhaled suppresses bronchial allergy in a large proportion of people affected, is already proving useful in reducing the frequency of attacks. In addition it is sometimes helpful to ascertain which proteins are particularly harmful by taking an accurate history, paying special attention to the circumstances in which the attacks usually occur. Such information may be supplemented by that gained from skin testing. Occasionally, when the patient is found to be allergic only to one protein, it is possible to under¬take desensitization, which involves giving injections of a very dilute solution of the protein once a week and gradually increasing the strength until finally a large amount can be injected without ill effect. This procedure is of particular value in those who suffer from hay fever and grass pollen asthma. -
The symptoms include a sore throat, hoarse voice, dry painful cough and wheezing. In addition, in small children, whose airways are normally narrow, inflammation may lead to dangerous obstruction with the production of a harsh, strident, inspiration noise known as a strider.
Chronic laryngitis which causes persistent hoarseness of the voice for days or weeks may result from excessive use of the voice (speaker's throat), but if it persists for more than three weeks the larynx should be examined to exclude either a carcinoma arising at that site or paralysis of the vocal cords from interference with the nerve supply to the larynx by a growth in the lungs.
Chronic bronchitis is an extremely common disease in the British Isles, also a very serious one as it may be associated with crippling, and at times fatal, complications. Its course may be divided into four stages:
1. Enlargement and over activity of the mucus-secreting glands in the walls of the bronchi
2. Bacterial infection of the mucus
3. The development of emphysema
4. Cardiac and respiratory failure
Stage I. The reason for the sudden production of excessive amounts of thick tenacious mucus is not known. It usually occurs in men over the age of 40, often seeming to follow an acute virus infection of the respiratory tract, and once the condition is established it is aggravated by many factors. Bronchitis is always worse in cold damp winter weather. The irritant effect of fog and industrial smog is particularly harmful but the prevalence of this has been reduced since the creation of smokeless zones following the passing of the Clean Air Act by Parliament in 1956.
The disease is also made worse by exposure to dust, fumes or sudden changes of temperature. In particular the dangerous irritant effect of cigarette smoking cannot he overemphasized. As soon as the diagnosis is made the patient must stop cigarette smoking and avoid all forms of bronchial irritation even if this means changing his job. Mucoid sputum is sticky and difficult to expectorate but this is often made easier by increasing its water content, either by inhalations of steam or by the use of a humidifier. The suppression of an irritant cough at night by a linctus containing codeine is helpful.
Stage 2. Intermittent acute episodes of infection are common. The patient feels toxic, is febrile, the wheezing and shortness of breath become more marked and in addition the sputum increases in amount and changes to a yellow or green colour. The bacteria usually responsible for this type of infection are the Hemophiliacs influenza and pneumonia. The antibiotics tetracycline and penicillin (Pertinent) are equally effective against these organisms. Sometimes a combination of penicillin and streptomycin (Crystalline Forte) is administered by intramuscular injection.
Stage 3. Repeated episodes of bronchitis associated with severe bouts of coughing put a great strain on the tissues of the lungs resulting in the development of emphysema. In this condition the walls of many of the alveolar rupture with the formation of large balloons or bullae while at the same time many of the surrounding capillaries are destroyed; in addition the lung tissue loses its elasticity with resultant difficulty in expelling air from the lungs. After a time the lungs remain in a constantly distended state with the chest assuming the shape of a barrel. These structural changes result in a serious reduction in the amount of oxygen entering the blood and an accumulation of carbon dioxide in the tissues.
Stage 4. When lungs already severely damaged by chronic bronchitis and emphysema are subjected to the added strain of an acute respiratory infection, respiratory failure may develop with a further marked lowering of the oxygen pressure and sharp rise in the carbon dioxide pressure in the blood. The amount of carbon dioxide retained in the blood is so excessive that it has an action similar to a powerful narcotic drug (carbon dioxide narcosis) with drowsiness, disturbance of behavior with agitation at times amounting to violence, rambling delirium, coarse flapping tremor of the hands similar to that seen in liver failure, and marked depression of respiration. This severe disturbance of the blood gases also adversely affects the heart and bl(axl vessels with the development of cardiac failure. Cardiac failure when it arises as a complication of disordered lung function IS sometimes referred to as car Pontianak.
Treatment includes the use of diuretics and the administration of oxygen. It must, however, be clearly understood that as carbon dioxide narcosis has a severe depressive effect on the respiratory centre in the brain the only stimulus to breathing is oxygen lack. If this stimulus is removed by the administration of pure oxygen the patient becomes increasingly drowsy and comatose until finally breathing ceases altogether. In view of this paradox a compromise has to be reached whereby the patient is given a mixture of oxygen and air using a Ventilate which is specially designed to deliver a 30 per cent mixture of oxygen with air. When respiration is markedly depressed the respiratory center can sometimes be artificially stimulated by the use of drugs such as alienation ( Da ptazole) or nikethamide (Coramine). Occasionally a tracheosionly has to be performed and breathing maintained by a respirator.
Bronchial asthma is characterized by episodes of severe spasm of the muscle in the walls of the bronchi. The attacks usually begin in childhood or adolescence but in some people the orisons later. When the disease begins in childhood there is often a history of other members of the family
suffering from either hay fever, urticaria, infantile eczema or a combina¬tion of these. The constriction of the bronchi is produced by an abnormal hypersensitivity or allergic reaction to proteins in the environment. This is called extrinsic asthma. The proteins include ones which are inhaled, such as pollens, moulds, house dust, animal hair, face powder and dandruff: also, but less commonly, proteins in food such as eggs, milk, fish or chocolate. In addition, the bronchi in an allergic subject may go into spasm in response to emotional stress. When the disease starts in middle age there is often no evidence of allergy to external proteins and it is assumed that such a patient must be allergic to his own internal body protein. This is called intrinsic asthma.
An attack of asthma starts suddenly with intense constriction of the bronchi so that within minutes the patient is wheezing loudly and gasping for breath. Cough and sputum do not appear until the attack has been present for some time. There is a wide variation in the frequency and duration of attacks from patient to patient. In between, an asthmatic may often appear to be in good health but frequent severe episodes lead to the development of emphysema, and in children result in loss of weight, stunted growth and deformities of the chest wall.
In asthma, as in other allergic disorders, there is a considerable increase in the number of eosinophil cells in the blood; in addition the sputum often contains solid plugs in which eosinophil cells may be found.
Status asthmaticus is a severe, prolonged, life-threatening attack of asthma requiring prompt, skilled and energetic treatment, Such an attack may be controlled by an intravenous injection of aminophylline but often the violent allergic reaction in the bronchi has to be suppressed by the injection of corticosteroids using either hydro cortisone, intravenously, or intramuscular injections of corticotrophin.
Formerly the routine treatment of asthma. 'included sucking a tablet of isoprenaline sulphate or the subcutaneous injection of a 1 in 1,000 solution of adrenaline, but these methods have been superseded since the introduction of broncho dilator aerosols containing either noradrenaline or adrenaline or orciprenaline (Alupent) or salutation (Ventolin) which are easy to use, readily portable and very efficient as they deliver a measured dose of the substance directly into the respiratory tract. Persistent incapacitating asthma requires the use of oral steroids such as prednisone or the twice or thrice weekly injections of corticosteroid (ACTH).
It is essential to try to prevent future attacks.
The recent introduction of disoditun cromoglycate (Inuit), a substance which when regularly inhaled suppresses bronchial allergy in a large proportion of people affected, is already proving useful in reducing the frequency of attacks. In addition it is sometimes helpful to ascertain which proteins are particularly harmful by taking an accurate history, paying special attention to the circumstances in which the attacks usually occur. Such information may be supplemented by that gained from skin testing. Occasionally, when the patient is found to be allergic only to one protein, it is possible to under¬take desensitization, which involves giving injections of a very dilute solution of the protein once a week and gradually increasing the strength until finally a large amount can be injected without ill effect. This procedure is of particular value in those who suffer from hay fever and grass pollen asthma. -
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