Stewart, John Lumsdaine

2019-02-15T14:23:27Z

2019-02-15T14:23:27Z

1955

A Historical, Physiological and Aetiological Review of the English Literature of Chronic Catarrhal Bronchitis with Special Reference to the Occurrenc of the disease in the British Isles and to the Writer's Personal Experience of cases during six years in General Practice.

CONCLUSIONS: 1. A review of the aetiology in each individual case is important and any aggravating factor should be dealt with appropriately. • 2. A definite disposition or constitution is necessary for the development of chronic bronchitis which may be looked upon as an exaggeration of the inspiratory phase of the respiratory complex. • 3. The relationship between infection and bronchial mucus constitutes the essence of the pathogenesis of the disease since the volume of the secretion is greatly increased and the inflammatory process in the mucous membrane reduces the number of cilia so that the means of moving the secretion fails and it accumulates. To what extent mucus is the result of hyper-sensitivity, infection and external irritants is not clear but presumably all three play a part. • 4. Hypersensitivity of chronic bronchitis is particularly related to infection, atmospheric pollution and climatic factors. Fog was found to aggravate the respiratory symptoms in patients with the disease in this series far more than any other single climatic factor although damp appreciably affected respiratory symptoms also. There was a reduction in the daily quantity of sputum in those cases investigated between February and May and this illustrated the beneficial effect of cleaner, warmer and drier air on the individual with the disease. Adverse weather and little sunshine prevailed throughout the summer of 1954 and six patients in my series had attacks of bronchitis in this summer and these patients normally only had attacks in the winter months. Dry weather and warmth diminished the cough in nearly half the patients in my series. Those who are fortunate enough to be able to do so should spend the winter in a warm dry climate and those who are unable to go away should endeavour to keep to an even temperature and remain indoors in damp foggy and windy weather in the winter months. Elderly people who live in a town or near the east coast and cannot afford to go abroad or to the south coast of England should endeavour to spend the winter in the country away from the east coast with country relatives if they are fortunate enough to have the latter. • 5. The age of onset of the disease depends on the habits, occupation, general health and previous general and pulmonary history of the individual and the sex affected is predominantly male. • 6. Occupations involving exposure to inclement weather, to dust and to risks of infection as well as those involving heavy muscular strain or prolonged exertion are unfavourable for those who suffer from the disease. Exertion aggravated the respiratory symptoms in over half of my series while nearly all those who were exposed to dust at their present or previous employment found that it aggravated their respiratory symptoms. Those engaged in unsuitable occupations which expose them to extreme variations of temperature, to dusty atmospheres or to inclement weather, should endeavour to change their occupations. The majority of cases in this series were employed in partly skilled and unskilled occupations. • 7. Smoking, excitement, heavy meals, coughing and exertion aggravated breathlessness in certain cases in this series. Patients with chronic bronchitis should be advised to reduce or stop smoking and lead quiet but not sedentary lives. They should avoid heavy meals and should diet if they are overweight. Over exertion should also be avoided and the patient should be provided with a cough sedative. • 8. The high incidence of the disease among relatives of those with chronic bronchitis suggests a hereditary predisposition. Chronic bronchitis seems to have a special incidence in some families. • 9. The development of the disease in a number of cases in this series was accompanied by attacks of bronchial asthma. A severe acute respiratory illness preceded the onset of chronic bronchitis in some cases and careful treatment of acute respiratory illness is essential if the onset of chronic bronchitis is to be avoided. In all cases with the disease upper respiratory tract infection should be investigated and treated as chronic upper respiratory tract infections are causative and predisposing factors in the onset of the disease. Respiratory complications following fevers and exposure to war gases may be predisposing factors in the development of the disease, and a considerable increase in chronic pyogenic pulmonary diseases may be expected in the coming years following the second World War. Two mothers in this series found that the disease developed after the birth of children. Exposure, shock and chronic pulmonary, cardiac and renal disease and structural defects should all be considered as possible causative and predisposing factors. • 10. Many of the patients studied in this series lived in tenements and a number of these tenements were overcrowded. A person who suffers from chronic bronchitis should be given priority for ground flat accommodation if he lives in the second or third flat of a tenement and those who live in overcrowded tenements should be given priority either for other tenement accommodation or lodgement in new housing schemes. New housing schemes should be built as far distant from factory smoke as possible and new tenements should be built with sufficient space between them to permit fresh air and sunshine to enter the rooms on all flats. It is hoped that with the introduction of the Clean Air Bill that there will be a reduction in the high incidence of chronic bronchitis in this country.

http://hdl.handle.net/1842/34098

The University of Edinburgh

Annexe Thesis Digitisation Project 2019 Block 22

Chronic catarrhal bronchitis: a clinical study from general practice

Thesis or Dissertation

Doctoral

MD Doctor of Medicine