Degenerative lung disease
I’ve had asthma all my life and, when I was 71, I developed chronic obstructive pulmonary disease (COPD), then bronchiectasis. My chest specialist gives me carbocisteine capsules to help me cough up the mucus, and I also have sprays. I’m told that as my problem is not centralised, I cannot have an operation. I am now 75 and am struggling daily with the problem.
COPD and bronchiectasis are both degenerative lung diseases caused by a breakdown in the structure of the lungs. Most, but not all, cases occur in smokers or ex-smokers or those who have been exposed to a lot of air pollution. In your case, a lifetime of asthma will have been an important factor. Once it has occurred it cannot be improved and tends to get worse. The focus then shifts on to controlling the problems it causes, such as breathlessness, cough and mucus production, as you describe. Inhalers are used to maximise the air getting into the lungs and will also reduce the frequency of infections and the amount of mucus produced.
Carbocisteine changes the consistency of the mucus, enabling you to cough more effectively and clear it from your airways. Any new infection needs to be treated promptly with antibiotics. So you will have to adapt to living with your condition and the limitations it imposes.
In a few patients, the condition of bronchiectasis is confined to a small area of the lung and can be surgically removed. Unfortunately, it sounds as though you are not in this category. I am sorry to hear that you are struggling with the problem, the therapy you are on sounds very appropriate but the most underused treatment is regular exercise. You can improve the performance of the lungs with exercise, even when they are diseased; some areas offer lung rehabilitation classes, so ask your GP if there are any in your area.
I have an essential tremor which, apart from getting worse, makes it very difficult to handle a spoonful of soup and I'm a positive peril to any carpet over which I carry a cup of tea. I gather the condition is incurable but is there a treatment other than the ineffective propranolol? I am reluctant to become a slave to the daily handful of pills. My mother, whose clacking teacup seemed to clatter against false teeth, in fact bounced her china against the frames of her glasses. I believe she had a similar condition.
Familial tremor is an inherited condition of the muscles or nerves, often most noticeable in the hands but also affecting the legs, eyes, head and any other muscle groups in certain people. You should be able to identify other family members with it and since it is usually inherited in a ‘dominant’ fashion, i.e. only one copy of the gene from one parent is enough to cause it, it will commonly affect half the children in each generation.
The tremor is of small amplitude and fast, usually about five per second, most easily demonstrated with outstretched hands. As you say it is distressing and permanent and often exaggerated by caffeine, stress and social settings.
Treatment is not very satisfactory. Propranolol is the first choice, with primidone next in line. They are both limited by side effects, so it is for you to judge whether the benefits exceed the limitations and in the case of propranolol it looks as though you have already done that. Other drugs exist that have occasionally been shown to be of use but there are usually good reasons why they are further down the list. I have one patient who finds that small amounts of alcohol, used judiciously (!), helps to control the problem in social settings.