A Question of Health: Breathe easy

After two years of violent coughing, antibiotics, steroids, X-rays, CAT scans and sinus operations, I have now been told that I have bronchiectasis. I am 55 and have never smoked. I have already had to cut down my teaching job from five to four days, but still feel extremely tired most of the time. I have been prescribed another month of the antibiotic doxycycline (the second course this year) and have been given an appointment to see a physiotherapist. Why have I developed this condition and is it progressive?

After two years of violent coughing, antibiotics, steroids, X-rays, CAT scans and sinus operations, I have now been told that I have bronchiectasis. I am 55 and have never smoked. I have already had to cut down my teaching job from five to four days, but still feel extremely tired most of the time. I have been prescribed another month of the antibiotic doxycycline (the second course this year) and have been given an appointment to see a physiotherapist. Why have I developed this condition and is it progressive?

Not many people have heard of bronchiectasis because it is relatively rare. But in the pre-antibiotic era it was a common cause of chronic coughing. The underlying problem is that part of the bronchial tree gets damaged, usually by an infection. The tubes that make up the tree become enlarged and they lose their ability to clear mucus. This mucus collects inside the bronchial tree and eventually it is coughed up in remarkably large quantities.

Pools of mucus are excellent breeding grounds for bacteria, so a cycle is set up that leads to episodes of bronchial infection and further lung damage. Antibiotics can break the cycle of infection, but they can't repair the damage that has already occurred to the linings of the breathing tubes. Physiotherapists can be helpful by teaching you a technique called postural drainage. This helps to get rid of the mucus and often reduces the violent coughing attacks.

Historically, whooping cough infection in childhood was a common cause of bronchiectasis later in life. The condition can also be linked to genetic conditions, such as cystic fibrosis. This usually causes severe lung problems at a young age. But it has recently been discovered that some cases of cystic fibrosis are relatively mild, and do not cause lung problems until later in life. If you are not already under the care of a lung specialist, it would be a good idea to be referred to one. Your lung function tests will need to be monitored regularly, and I wouldn't be surprised if you end up taking long courses of antibiotics fairly regularly. The British Lung Foundation has published a fact sheet about bronchiectasis, which you can find on their website www.lunguk.org.

PRESSURE IS ON

My husband, aged 57 years, has been taking medication for high blood pressure for 10 years. He has never been entirely happy with this regime and, of late, has sought information on alternative strategies. He consulted a self-styled expert in a health food store who recommended calcium magnesium citrate tablets. My husband stopped taking his regular medication and has started on the latter. To be fair to him, he has a healthy lifestyle, doesn't smoke, drinks occasionally, and is not overweight. When he took his blood pressure with a home machine in the last week, sure enough the blood pressure was down below the level when he was taking the prescribed tablets. Please give me your opinion. I am sceptical, but wonder whether his sheer relief at not taking the tablets he so hated has reduced his stress levels.

There is a genuine link between magnesium and blood pressure. One study that looked at 30,000 American male health professionals discovered that those with high magnesium intake were less likely to have high blood pressure that those with low magnesium intake. Another large study called Dash (Dietary Approaches to Stop Hypertension) suggested that high blood pressure could be significantly lowered by a diet high in magnesium, potassium, and calcium, and low in sodium and fat.

Before he throws away his blood pressure medication , I would make sure that your husband's blood pressure is genuinely under control. Some home blood pressure machines are less reliable than professional machines. Foods that are especially rich in magnesium include bran, peanuts, wholemeal bread and sardines.

HAVE YOUR SAY

Plenty of advice has arrived for the grandparents of a four-year-old with constipation problems.

RD from London writes:

We had the same problem with my daughter when she was three. It all started with potty training – at some point she became afraid of opening her bowels, whether in response to a painful motion or some other factor, we are not sure. She would hold on to her poo for days and even weeks, rocking on the floor when it became difficult, then eventually giving in and producing a huge poo in her pants. As she was starting playgroup, we had to sort it out. We followed the advice of Gina Ford in her book From Contented Baby to Confident Child. We fed my daughter the highest fibre diet we could devise, and gave her lots of fresh fruit juice to drink. Within a week, she had no choice but to open her bowels every day. Whether it was in the potty or in her pants, we just said how nice it was to do a soft poo every day. Because her motions were no longer painful, she gradually got over her fear, and started to ask for the toilet in good time. A problem that had been going on for months was resolved within just a week.

LF from Yorkshire recalls:

Thirty years ago, one of my children had a similar problem. A health visitor suggested that we apply a blob of Vaseline after each bathtime or bottom wipe, and it worked like magic.

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