DR MARTIN SCURR: Try physio to ease chronic coughing

My wife Patricia has many illnesses including asthma, bladder problems, Crohn’s disease, type 2 diabetes and bronchiectasis. The latter condition causes bouts of chesty coughing, but we have been told there is no cure. I would appreciate any advice.

Brian Jones, Torquay, Devon.

Bronchiectasis is a chronic, irreversible lung condition, and coping with it must be hard for your wife — especially in the context of her other health problems. It is typically associated with a cough, producing sputum that is difficult to shift.

Bronchiectasis occurs as a result of the gradual destruction of the walls of the bronchi (the main passages to the lungs) and other airways. 

This causes the bronchi to widen, and can lead to the lining breaking, bouts of infection and the patient coughing up blood. The condition may also inflame the airways, obstructing the airflow.

It can have a number of causes, including chronic obstructive pulmonary disease (COPD — an umbrella term for a group of common lung conditions, including emphysema), rheumatic disorders such as rheumatoid arthritis, and genetic diseases such as cystic fibrosis. 

In the days before widespread immunisation against whooping cough, childhood infection was also a major cause.

It’s thought that asthma and bronchiectasis are related, because both cause inflammation of the airways.

If someone has both conditions, asthma may prevent the proper diagnosis of bronchiectasis, as coughing, breathlessness and sputum production are symptoms of both.

A CT scan of the lungs is used to confirm the diagnosis — this will show changes in the appearance of the air passages leading to the lungs, including their widening and thickened walls.

Your wife may have to take antibiotics if there is an infection. Ideally, a sputum sample should be tested to identify the bacterium responsible and pinpoint the correct antibiotic to treat it.

The mainstay of treatment for bronchiectasis is daily chest physiotherapy. This can help with the drainage of sputum, and involves sessions with a physiotherapist who can advise on postural changes that encourage it to be coughed it up.

Once the technique is learned it must be used in long-term regular sessions, once or twice daily.

What will be helpful is for your wife to stick with the chest physiotherapy. The more she can clear the sputum, the less the continuing inflammation and infection will trouble her. Her GP should be able to refer her for this treatment.

I’ve had heart palpitations for around three years, which have caused panic attacks. Tests have shown that everything is fine, but in 2019, after seeing a stressful moment between my husband and his parents, these attacks became painful. Now, whenever there is an anxious episode these happen. I am 37.

Sheryl Styles, Cambridge.

You can be reassured that your symptoms do not indicate anything serious, as this would have been picked up by the tests you mention.

As you say, the painful thumping heartbeats are triggered by anxiety, and even though rationally you understand why you feel this way, I would guess this has become an involuntary reflex, which began when you witnessed the emotional moment you describe.

The reaction is kickstarted by the sympathetic nervous system, which acts largely unconsciously to regulate many bodily functions such as core temperature.

It also activates the changes needed to ensure survival when threatened. This all starts in the amygdala of the brain, an area that processes fear and stress responses. It is connected to the hypothalamus, which activates the pituitary gland, releasing hormones which stimulate the adrenal glands.

This, in turn, triggers the release of cortisol and adrenaline, the stress hormones. These increase activity in the vagus nerve (which runs from the brain to the colon via many internal organs, including the lungs and heart), causing the tightness in your throat which you mention in your longer letter.

The vagus nerve is partially responsible for the increase in heart rate and blood pressure, and, combined with the adrenaline, this leads to the more prominent heartbeat you experience.

I think you would benefit from a form of talking therapy called cognitive behavioural therapy (CBT), as this aims to alter the way you react to stress. Your GP can refer you to a clinical psychologist.

Write to Dr Scurr

Write to Dr Scurr at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email [email protected] — include your contact details. Dr Scurr cannot enter into personal correspondence.

Replies should be taken in a general context and always consult your own GP with any health worries.

In my view… Smell the coffee about overdoing the fruit juice

Fruit sugar may sound harmless, but recent research in the journal Frontiers in Pharmacology confirms the life-threatening risks posed by the large amounts we consume these days — essentially because of its role in weight gain.

Fruit sugar, or fructose, is often found in processed foods, where it is mainly derived from corn starch.

Through evolution, our intestines have adapted to digest fructose in the quantities obtained from fruit. However, the larger amounts in commercially processed fruit juices and other foods swamp the natural mechanisms and are absorbed, moved to the liver and turned into fat.

This is one of the reasons why, in recent years, there has been an ever-rising incidence of non-alcoholic fatty liver disease, which is now thought to affect one in three adults in the UK.

When severe, it develops into an even more worrying condition, non-alcoholic steatohepatitis. This can in turn lead to severe scarring of the liver (cirrhosis), and an increased risk of liver cancer.

But it’s a different story with coffee.

A separate analysis of recent studies has given us clear evidence that coffee drinkers are 39 per cent less likely to develop cirrhosis, and consuming greater amounts of coffee (more than two cups a day) increases that figure to 47 per cent.

This is thought to be because, when it’s digested, chemicals in coffee are converted into paraxanthine, a compound that slows the growth of scar tissue (seen in cirrhosis).

Two other chemicals in coffee, kahweol and cafestol, may also help prevent liver cancer.

The upshot of this is that it’s time to cut back on the fruit juice and smell the coffee instead.