Respiratory System

Breathing is under rated.  No, I really mean that.  Usually our breathing is such a passive thing and for much of our life.  It’s no wonder then that when someone is taught to meditate, so much emphasis is then put on breathing, perhaps to allow us to appreciate the wonder of life from this simple act.  Personally, meditating and focus on breathing always made me feel more short of breath, so I rather like to take it for granted.  So takes a look at what we need to know about our respiratory system, the system that helps us fulfill this simple wonder.

SHORTNESS OF BREATH

This is such a common feeling that can come over an elderly person.  And when it does, it can be from something really major or something small.  Let’s take a deeper dive into some common and important causes of shortness of breath:

1. Not enough blood – “anaemia”. If you lose blood, then eventually your body gets deplete of oxygen and you feel short of breath. This can happen either in a hurry when there is a blood vessel leaking somewhere in your body, for example, within your guts/ bowel or stomach.  Or, it can happen slowly where you have a chronic disease which is hampering your body making blood or you have some other disease which is causing you to lose blood slowly (for example bowel cancer).  Low iron, as a consequence of long term blood loss, inadequate intake from your diet or poor absorption can go on to itself slow blood production and cause a low blood level in your body.  A person who has anaemia looks pale and may have low blood pressure and a fast heart rate.
2. Chronic lung conditions. Many chronic lung conditions can contribute to shortness of breath.  These include asthma and chronic obstructive pulmonary disease or emphysema (from long term smoking).  These diseases may cause a person to often get wheezy as well as feel short of breath.  They may be associated with increased production of phlegm and coughing.  These conditions improve by treating both infections, usually with antibiotics and treatment to decrease inflammation and expand your airways.  This comes in the form of inhalers including salbutamol (Ventolin) and various steroids.  Sometimes, if you’re quite short of breath, it may be useful to take oral steroid (a tablet) called prednisolone.  This can be for a short period of time, anywhere between 3 days to 14 days, with a decreasing regimen.  The precise dosage can be recommended by a doctor.  However, it’s really handy to keep such things close at hand in your medicine cabinet, in case you need to improve your breathing during an infection, particularly if you get wheezy.  Prednisolone is essentially a very strong anti-inflammatory agent, helping your lungs to “calm down” somewhat during an infection.  At the same stage, prednisolone works by supressing your immune system and has other longer term side effects, so you don’t want to take it for too long, if you can avoid it.
3. Heart problems. If you have a heart attack, you may feel shortness of breath, usually all of a sudden.  This is particularly true for people with diabetes.  Apart from this, if you have long term heart issues, your heart may not pump the volume of blood it used to pump in the past.  Eventually your blood gets somewhat backed up and this back pressure leads to the collection of fluid in your lungs, as well as your legs.  This is called “heart failure”.  That extra fluid which is backed up in your lungs, caused by your weakened heart, makes you feel short of breath.  It could also cause wheeze.  You may notice your legs swelling. A tell tale sign of shortness of breath being caused by heart failure is that when you lay in bed, you feel more short of breath.  This may cause you to use more pillows at night, or even sit up, since being upright improves your shortness of breath.  A way to keep an eye on this is by monitoring your weight.  Provided your not eating more and exercising as you usually would, if your weight is rising, then chances are, that extra weight is fluid from heart failure.  You’ll perhaps see your legs swelling more as well.  If these things are happening, then it’s likely your shortness of breath is related to a weak heart.  In this case, the treatment is a diuretic, which is a medication which causes you to lose fluid.  The typical diuretic is called “frusemide”.  This drug causes your kidneys to retain less water.  Therefore, when you take frusemide, you will find yourself urinating more.
4. Pulmonary embolism. In a related chapter, we talked about deep vein thrombosis, and how that a blood clot which has formed anywhere within a vein in your body, can dislodge and travel to your lung, getting stuck there.  This blood clot, now located in your lung, is called a pulmonary embolism.  A pulmonary embolism causes an area of your lung to have no blood flowing through it.  That area of your lung can collapse and not function, leading to shortness of breath and sometimes the coughing up of blood.  It can also cause sharp chest pain when you breathe in.  Sometimes rather than one massive pulmonary clot, people do get smaller clots, over a slightly longer period of time, perhaps weeks, lodging in their lungs, and over time, this can cause increasing shortness of breath.  So always keep it in mind as a cause, particularly if you are relatively immobile and sit a lot.  You may notice your leg swelling, getting painful and red.  This could be the source of the clot which is going to your lungs.
5. Heart rate issues. We discuss in the section for the cardiovascular system how heart rate issues (heart beating too fast or too slow) can lead to shortness of breath.  This is very true since your heart rate is a major determinant of your blood pressure.  If your heart rate is too fast or slow, your blood pressure can drop and you can feel short of breath.
6. Mental origins to shortness of breath. This is a very common cause of shortness of breath.  Obviously other causes need to be considered, but a person who once gets short of breath from say asthma, or any other cause, rather remembers that experience, particularly if it happens repetitively.  And, all those of episodes of shortness of breath, can make them increasingly aware of their breathing.  Eventually, if you have lung conditions, you really do become very “aware” of your breathing and that constant awareness of something so fundamental as breathing itself, can start to drift into itself making your feel short of breath, worsening the situation.  This really is a form of health anxiety and it’s very understandable, particularly those with chronic lung conditions such as emphysema.  Often times, the mental stress and fear of having acute breathing issues, carries with them, and they are left in that anxious state about their breathing.  If you have chronic lung or heart conditions and have issues with your breathing along the way, you are very much at risk of this happening.  This shortness of breath, contributed to by your fear of that very same thing.  In this case, it may be worthwhile to slow your breathing, and maybe see a psychologist to get some other advice about how to control that part of things.

Even if you don’t have chronic lung or heart conditions, feeling short of breath can be associated with various mental states including depression and anxiety.  It’s really useful to consider your mind  state this way, and how it’s contribution to how you feel about your breathing.

TIPS:

1. Remember, acute shortness of breath, even in the absence of chest pain, could still be from a heart attack. This is especially true if you have diabetes.
2. If you get episodes of shortness of breath, and are well between, it could well be from your heart beating too fast or slow. During such an episode, sit down and if you have an automatic blood pressure cuff, wear it.  Although the accuracy may be reduced during such an event, it could show important information about your heart rate and blood pressure at the time.  Record this information and give it to your doctor the next time you see them.
3. Exercise is really important. Your lung function is a case of “move it or lose it”, so nearly all conditions benefit from some form of exercise.  The best exercise is usually just making sure you go for a walk every day if you can. Nothing fancy.
4. Inhalers/ puffers – such as salbutamol (Ventolin) can be helpful – if you use them properly. There are many devices these days which act as inhalers.  Make sure you really know how to use them.  Often people may be using an inhaler in an incorrect way, and this causes it to be ineffective.  Don’t let that be you.  Ask your doctor how to best use the device you’ve been prescribed, so that you get the maximum benefit out of it.
5. It is useful to check your weight periodically.  Don’t get obsessed by it, but certainly checking your weight maybe once a month will let you potentially keep a nice measure of your fluid status.  If you can’t explain why your weight is going up, then it may well be that you’re retaining fluid in your body, and a reason for that will need to be considered.  It could be your heart, although there are other causes including loss of kidney function.
6. Do your best to stay relaxed in your life. I’ve seen many patients get escalating anxiety as they get older.  This can be worsened if you have heart or lung conditions which cause you to have difficult breathing.  But your mental state, and trying to remain a calm person, really can help you a great deal feel less short of breath, or at least help you cope with your medical problems more.  There are various ways to stay more calm, both medication and non-medication based.  Be open minded about this.

COUGH

Once again, a very common symptom.  And once again, can be very annoying to the sufferer!  The common causes of a cough are:

Infections

Infections can be short term events, or longer term infections such as what is know as bronchiectasis.  Respiratory infections can also be classified essentially as bacterial or viral.  A viral infection causing a cough can have the symptoms of a sore throat and runny nose.  By contrast, a bacterial infection, may well just be a cough.  Both can cause fever.  And, remember, it’s not uncommon for a viral infection, to lead to a bacterial infection.  This is called a “secondary” infection.  Dry coughs can be either viral or bacterial.  It’s hard to know.  A few rules would be that if you have a very runny nose, you’ve likely got a virus, at least initially.  If your phlegm is getting more thick and colourful, then it could well be a bacterial infection.

In general, if you are getting more unwell with your cough, and not sure if it is viral or bacterial, then best to see your doctor and consider antibiotics.  Many elderly people go get pneumonia, which is a more significant infection within the lung itself.  This should be treated early, usually with antibiotics.  At this time, your lungs may also become inflamed and sensitive.  This will present as wheeze, and your doctor may prescribe a steroid – prednisolone to control some of that.  Provided you are not allergic to penicillin, your doctor may prescribe amoxicillin.  Alternatively doxycycline or roxithromycin may be used. These antibiotics are typically used for one week.  However, if you are feeling improved with the antibiotics, but not quite better, it may be appropriate to have another course.  Try to continue on with the second lot of antibiotics in this case, rather than allowing a gap between courses.

Influenza needs to be brought up here. When someone gets the “flu”, they could well have all the other symptoms of a virus – runny nose, sore throat, cough.  However, the defining difference the degree of body aches.  Influenza causes your whole body to ache.  You may have a high fever, alternating between chills and feeling very hot.  You’ll likely feel very tired.  It is really important to drink fluids, especially water, during this time.  Remember also that the flu can go on to lead to a bacterial chest infection.  So, if your phlegm starts to get thick, consider this.

TIPS:

1. Vaccinations – consider the influenza vaccination, whooping cough vaccination and the pneumococcal vaccination. These could help you.
2. Do some deep breathing. When you have respiratory infections, one way or another mucus and secretions may collect in your lung, usually the bases.  Even if you don’t have an infection, just sitting down in a chair too much can cause some parts of your lungs, typically the bases to collapse.  You should consider doing deep breathing to keep all these parts of your lungs well aerated.  This could become a suitable daily exercise, whereby you start and end your day perhaps by doing some deep breathing exercises, even when you’re well.  Better still, do this outside, getting some fresh air.  When you take deep breaths, it can cause you to become light headed.  This being the case, perhaps do them sitting down, provided you are upright enough allowing you to still open up the bottoms of your lungs.
3. Always consider providing a sample of your phlegm to the doctor if you’re not improving. In this case, your infection may be a resistant type, and that phlegm sample may prove vital to decide what antibiotic to use.  If your doctor hasn’t given you a jar for this purpose, you can simply take your own jar.  However, it’s a useful thing to keep a few of these pathology specimen jars at home since the same type of jar is often also used to collect urine.  This allows you to take samples to the doctor when you’re unwell.
4. Drink plenty of water. As long as you’re not on a fluid restriction for any reason, drinking fluids will stop you from getting dehydrated. This can happen when you’re sick and that dehydration can end up being as dangerous as the primary sickness itself.
5. Keep in mind whooping cough. If you have a dry cough which just doesn’t go away, it may be the whooping cough.  In adults, the whooping cough is known for causing a long standing cough, giving rise to the disease being referred to as the “100 day cough”.  Your doctor can test you for this.
6. If you think you have influenza, the “flu”, then get tested. Your doctor can test you for the flu with a sample of mucus from your nose.  The flu can be dangerous, and it’s good to know whether you’ve actually got it or not.

Chronic lung conditions

Asthma and chronic obstructive pulmonary disease and emphysema can all cause a chronic cough.  These coughs worsen with infection.  It’s really important to consider when you have an infection, and consider using antibiotics early, because you are more at risk of getting a more significant chest infection.  Also, you will likely need prednisolone as well, to manage the inflammation in your lungs.  This inflammation and constriction may present as wheeze.

Reflux

Sometimes people can just have a dry cough which lingers despite all sorts of cough medications.  If this is your case, then you could consider – is your cause actually from acid travelling up to your throat from your stomach.  This is possible.  When that acid gets high enough, it reaches a muscular ring called your cricopharyngeus.  This muscle is located roughly at the intersection of where your upper throat branches into your wind pipe (trachea) and gullet (oesophagus).  When acid hits this muscle it can go into spasm and cause you to feel tight in the throat, or at times cough.  To test this, you could trial a medication which decreases stomach acid.  These medications are called proton pump inhibitors, esomeprazole would be one such drug.  Taking this daily for one month would be a sufficient test.  If acid reflux is your cause of a cough, your symptoms should improve after this time.

Heart failure

Your heart is a pump used to pump blood around your body.  The heart pumps blood which is rich in oxygen out through your arteries.  Your body uses the oxygen in your blood.  That blood which is now deplete of oxygen flows to your veins from which it is sent back to your heart.  From your heart that venous blood is pumped to your lungs and from there, it returns to your heart to once again get pumped into your arteries.  However, for different reasons, including after having a heart attack, your heart can get weak and when it does its ability to contract and act as a pump diminishes.  In this case, blood which returns to your heart, struggles to be pumped out to your arteries.  The pressure builds backstream and the net result is that fluid collects in your lungs.  This fluid in your lungs can cause you to be short of breath, wheeze and indeed cough.  If this is your problem, you may well also notice that your legs are swelling with fluid.  In this case, your feet or legs will be swollen and when you pressure your finger into your shin for 10 seconds, you will notice that your finger leaves an indent, this is called “pitting oedema” and it is typical of fluid which is caused by your heart failing this way.

Of note, if your cause for a cough is heart failure, your problem will be worse when you lay down at bed.  In this relatively flat position, because of the redistribution of fluid around your body, your lungs collect with even more fluid and your tend to feel more short of breath and cough more.  You may find yourself increasing the number of pillows you need to sleep on, to prop yourself up at night, saving that feeling of shortness of breath and coughing when you lay more flat. Since the problem with heart failure is that your body ends up retaining too much fluid, the treatment for this is to limit your water intake (usually to a maximum of 1.5litres per day) and consider taking a medication which helps your body get rid of fluid.  This medication is called a diuretic and frusemide is the usual drug of choice for this purpose.

Medications

There are some medications which can cause you to cough. The most typical of these are a class of medication used to lower blood pressure called ace inhibitors.  Perindopril is one such medication.  These medications can cause you to get a dry cough at any time, even if you have been taking them for a while.  There are similar blood pressure medications which can also cause you to cough.  The main point is, consider what medications you are taking and whether they could be causing or at least contributing to your cough.

TIPS:

1. If you have a cough and think you have an infection, collect a sample of your phlegm in a jar and take it with you when you see your doctor. They will be able to then send it for testing.
2. Keep an eye on your weight. If you are putting on weight and yet you haven’t changed your diet, it could be that your body is retaining fluid and that some increased fluid is in your lungs contributing to your cough.  In this case, check your legs for any swelling.
3. If you are a smoker or have smoked in the past and have a chronic cough, you really should have a chest xray to be sure.
4. If you start coughing up blood, you really should talk to your doctor. There are different causes of coughing up blood including a pulmonary embolism, lung cancer or trauma at the level of your throat.  Worthwhile working out what’s going on with your doctor.