A Question of Health: Get it off your chest

How can I clear my lungs of viscous and sometimes globular secretions, which are very hard to dislodge? They are white/greenish yellow. It all started after a heavy bout of influenza, when the secretions from the nose would not stop. Eventually my sinuses were washed out by an ENT surgeon. Unfortunately, the infection turned into bronchitis and would not budge, even after heavy doses of antibiotics. Cough syrups do not help. If the symptoms cannot be cured, is there a way to make it easier to expel the substance?

GET IT OFF YOUR CHEST

After more than 25 years of chronic catarrh and chronic bronchitis, I am at my wits' end. How can I clear my lungs of viscous and sometimes globular secretions, which are very hard to dislodge? They are white/greenish yellow. It all started after a heavy bout of influenza, when the secretions from the nose would not stop. Eventually my sinuses were washed out by an ENT surgeon. Unfortunately, the infection turned into bronchitis and would not budge, even after heavy doses of antibiotics. Cough syrups do not help. If the symptoms cannot be cured, is there a way to make it easier to expel the substance?

If it has been going on for 25 years, there is not going to be an instant cure. If you cough up mucus and phlegm for three months a year for at least two years, you are officially defined as suffering from chronic bronchitis. If this interferes with the ability of your lungs to function normally, you probably also have chronic obstructive pulmonary disease (COPD). You don't mention if you have been a cigarette smoker. Smoking is by far the commonest cause of both chronic bronchitis and COPD. First of all, if you are a smoker, you must stop. There is no hope of getting things better if you continue to pump smoke into your lungs. Thick secretions are difficult to shift. Mucus can sometimes be made less sticky by increasing the amount of moisture it contains. If you don't drink much liquid during the day, you should increase your fluid intake. You should try to humidify the air in your environment. At home, this may mean simply putting some bowls of water on the radiators. If you want to be more sophisticated, you can buy an air humidifier, that pumps steam into the atmosphere. You might even want to try a nebuliser. These are usually used as a way of inhaling drugs for people with asthma, but there is no reason why they cannot be used with plain water. The nebuliser turns the water into a fine mist, which you breath in through a mask. There is one drug that has been shown to be effective in loosening and thinning secretions. It is not available on the National Health Service, but you can get it on a private prescription. It is called carbocisteine (its trade name is Mucodyne).

NIGHTLY DISTURBANCES

I am a 67-year-old woman and over the past six months have experienced difficulty in controlling my bladder. I need to get up three or four times during the night. During the day, if I am unable to get to a toilet immediately I feel the need, I have an accident. I have had some tests to establish that there is no serious underlying cause. My GP has suggested that my bladder muscle has weakened with age. Are there any exercises I can do to strengthen the bladder muscle? The prospect of never having a full night's sleep again is worrying. The lack of sleep is beginning to tell.

I don't agree with the suggestion that your bladder muscle has weakened with age. The muscle is obviously strong enough to empty your bladder, which is all it is meant to do. The real problem is that the bladder muscle has become irritable and unstable. It tries to contract even when your bladder is not yet full. This is why you need to go to the loo frequently, and why you are getting up in the night. Age is a factor in this problem, as this is a common problem for women in their sixties and beyond. I don't think exercises will help, but there are drugs that will help you. You should ask your doctor if you can try either oxybutynin or tolterodine. They are both very effective in helping unstable bladders. They are safe and relatively free of side effects, although you may notice that your mouth feels dry when you start taking them.

I'LL DRINK TO THAT

Twice in recent weeks readers have written to you expressing the belief that a small amount of alcohol is good for you. I fear their belief is based on a false interpretation of the facts. It may be true that people who consume moderate amounts of alcohol are healthier than non-drinkers. But this may not be a matter of direct cause and effect. It could be that moderate alcohol consumption and good health are both effects, and that the cause of both is a balanced personality. In the context of our Western culture, total abstainers are likely to have an uptight, obsessive personalities, which are not conducive to good health.

Researchers who have looked into the health benefits of alcohol consumption have tried to separate the effects of "personality" from the effects of alcohol. The evidence is that drinking moderate amounts of alcohol is beneficial to health, independent of what type of personality a person has. There has also been plenty of research carried out on the subject of health and personality types. This is a much more difficult area, because personality is more difficult to measure than alcohol intake. Sadly, some relaxed and easy-going people die prematurely, and some uptight obsessive people lead long and healthy lives.

HAVE YOUR SAY

Help from JA for the reader with a chronic choking sensation:

I too suffer from loss of voice, sore throat, dry coughing, choking and other symptoms. In two-thirds of patients with these symptoms, gastro-oesophageal reflux is a significant factor. Your reader should look at the web page of the Wake Forest University Center for Voice Disorders ( www.bgsm.edu/voice). Following an endoscope examination, my ENT specialist states that the lower sphincter is lax, allowing acid gas to escape upwards from the stomach and damage the throat. Treatment includes reducing waistline, small meals, no chocolate or peppermint, and little alcohol. All of these have helped, together with having no meals after 7pm and the steady use of Gaviscon at night.

Please send your questions and answers to A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS; fax to 020-7005 2182 or e-mail to health@independent.co.uk. Dr Kavalier regrets that he is unable to respond personally to questions