Open your window in just about any busy city in the world and take a deep breath. That is, if you dare risking the coughing, congestion, and inflammation that comes from a lungful of urban pollution. While these symptoms are a nuisance for healthy people, for patients suffering from chronic or serious lung disease, the matter could be one of life and death. But at least you can retreat to your home to enjoy the clean air, right? According to work done by Dr. Pai-Chien Chou, Taipei Medical University Hospital’s new Director of Thoracic Medicine and his team, your home might not have less air pollution than the bustling streets outside. Dr. Chou’s cutting edge work combining advances in medication, rehabilitation, and technology should help provide a solution.
Dr. Chou came to TMU Hospital in May of 2018 after almost two decades in thoracic medicine at Chang Gung Hospital. In part he wanted to join his classmate from the Imperial College of London, now Dean of Medicine at TMU – Dr. Han-Pin Kuo. Dr. Chou also wanted to break away from the status quo in pulmonary medicine. “I tried to join him to do something different compared to the other pulmonary medical specialists,” he said.
After studying thoracic medicine in the UK, Dean Kuo was the first doctor to introduce positive drainage techniques and the use of antibiotics rather than steroids for the treatment of bronchiectasis (a widening of the airways with a buildup of mucus) to Taiwan in the late 90s. Lungs of patients with bronchiectasis lack the changing airway diameter that create the pressure difference needed to force mucus out of the lungs when coughing. The sputum that remains in the lungs becomes a breeding ground for microbiota that can lead to deadly pneumonia. And even if the patient is treated using antibiotics, mucus without bacteria is still inflammatory in nature and can damage the lungs’ mucosal lining. To get rid of the dangerous excess mucus, patients are connected to a positive pressure machine that detects inhalation, adding pressure to help keep the airways clear.
This positive drainage technique combined with antibiotic-steroid treatment is now a mainstay in the treatment of bronchiectasis. Treatments are now being paired with non-pharmacological techniques that use gravity, posture, specially placed pillows, and education in producing good coughs to facilitate the drainage of sputum. This kind of pulmonary rehabilitation can be effective, “We change the fate of some patients, patients willing to follow the steps we teach in pulmonary rehab,” said Dr. Chou.
Starting treatment as soon as possible is important. “If you want to have better life quality, you must start as soon as possible. If you can reduce the bacterial burden, your airway can recover a bit more easily.”
But the drainage process can be taxing, and unfortunately not all patients are able to keep up the regimen of coughing up sputum three times a day for thirty minutes each session. Drinking lots of water can help reduce sputum viscosity, but that itself presents difficulties for people who risk dizziness and falls when they get up quickly at night to visit the bathroom.
Dizziness and weakness caused by hypoxia is a new area of inquiry. “Previously we only noticed that the patient has some airway obstruction or not. But we now found a trend that if a patient has dyspnea (meaning they can’t breathe well) related to airway obstruction due to hypoxia.” This is an important finding related to prognosis, as in a hypoxic environment airway inflammation will become worse regardless of what bronchodilator is used.