About Gary Expertise Will attempt to answer any question on respiratory disease, but please don`t ask me to make a diagnosis. Although I`ve worked as a respiratory specialist nurse in the UK for 6 years, I know nothing about the health systems of other countries. I have a particular interest in asthma, COPD, spirometry, and tuberculosis.
Question Hi
I am a 50yr old male and I was diagnosed with asthma approx. 10yrs ago by the family Doctor which seems to be worsening over the years. Recently I visited a Pulmonologist, who after various breathing tests informed me that I was COPD. (Looking through previous questions I can relate to the problem more now than before.)
At this time I am taking 1xpuff Seretide(morning), 3xpuff Duovent daily and 1xtablet Singulair (night)and nebulise Bisolven every so often
The problem is I have mucus/sputum/phlegm clogging my lungs which I cannot expel. It seems to come up my chest when nebulising with the Bisolven and that is where it stays, no amount of coughing or forcing will relieve it.
I have tried expectorants with no luck.
I feel like my lungs are been drowned with mucus
Coughing to expel this mucus also puts me out of breath
Any ideas?
Answer Hi Reg
COPD Guidance in the UK suggests that mucolytics (like Bisolven) which are meant to make it easier to expectorate (get rid of) mucous don't actually work. They have no role to play in the routine management of COPD in the UK, and I'm not aware of any other research to suggest otherwise (however, they may figure in the COPD guidelines of the country you live in, do you live in the US?). So perhaps you don't need the Bisolven. Why not try without it for a while and see how you get on. Also, there is no evidence at all that expectorants work, so don't waste your money. I know this doesn't answer your question, but it helps if people only take drugs that are actually helpful.
Mucous hypersecretion (too much mucous like you describe) is common in both asthma and COPD. This is because of the inlammation that takes place. If yours was being caused by asthma then the therapy you are currently on would be appropriate. However, I would try increasing the dose of Seretide to twice daily (morning and night). Also, you don't say which strength of Seretide you take. It might be worth asking your doctor or nurse if you can step up. The reason i suggest increasing the amount of steroid you are taking is because mucous hypersecretion occurs as part of the body's inflammatory response. Inflammation is the root of the problem in asthma and steroids are the main anti-inflammatory agents used in managing it. Often, symptoms are not kept at bay because the patient isn't receiving enough of the steroid, so increasing it and seeing how you get on is a perfectly reasonable suggestion. If it makes no difference, you can reduce the dose again, but give it a few months to see if it helps.
You might also ask your doctor or nurse about increasing the duovent. 3 puffs a day is not much and I know many patients that take a lot more than this. Duovent contains a drug called "ipratropium" which has the side effect of drying secretions in the body. whilst many people don't like this side effect (such as having a dry mouth) it has been helpful in others that i know of because it might help to dry the mucous up. There is little research evidence of this but I know patients that have produced less sputum when they increased it.
If the pulmonologist thinks you have COPD ask him/her if you can also drop the Singulair. This is because whilst there is good evidence that it works in asthma, there is little evidence that it works in COPD (this is because the inflammation that occurs in the 2 diseases are caused by different pathological processes in the airways, and so they respond differently to different therapies).
If you have recently given up smoking then producing lots of sputum is normal in the initial period. this settles down in time though. This is because smoking paralyses the little hair-like structures in the airways (called cilia) so they can't waft the mucous upwards so you can spit it out. Then, when you stop smoking, they aren't paralysed anymore and start shifting the mucous again, and you notice it too. This settles in time though.
Finally, many people with COPD find that no drugs help with getting rid of the sputum they produce. You can ask your doctor or nurse about trying "postural drainage". This is a type of physio that people with other sputum-producing lung conditions do (such as bronchiectasis). It helps in those conditions and, whilst it isn't conventional therapy for COPD, I know people that have tried it and it has helped. a quick search for "postural drainage" or "bronchiectasis" on Google should lead you to a decent description of what's involved, but check it out with your doctor or nurse first as it may not be suitable for you (I don't know your detailed history so can't comment).
