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A Cause of Breathlessness in Elderly Persons and Its Treatment
A special and chronic form of breathlessness found in elderly sufferers from asthma and bronchitis, pulmonary emphysema is due to a permanent dilatation of the minute air spaces of the lungs. Blowers of windinstruments are also said to be particularly liable to it. The condition, which is not fatal and need not be regarded as grave, is described here the treatmentis indicated and notes on its avoidance are given.
The breath should leave the body easily and in an effortless manner. Sometimes, however, this does not happen, and so there is straining when breathing outwards. Such straining throws a heavy back pressure on the air cells of the lungs and so tends to stretch them and even to tear them. When that occurs ihe resulting trouble is termed emphysema.
The commonest causes of emphysma are asthma and bronchitis, and the complaint is most common in elderly people who have lung trouble in winter. It is very seldom met with in fit young people. Indeed, it comes on very slowly and gradual, each attack of bronchitis making it worse. It is not fatal; but it weakens those who are subject to it and makes them less well able to withstand the attacks of disease. If a patient with emphysema gets pneumonia his chances of recocery are not very good.
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Most frequently a menstrual period has been missed and the patient think she may be pregnant. Very soon acute attacks of abdominal pain come on which vary in intensity, but may be so severe as to cause complete collapse and fainting. The commonest time for this pain to appear first is about ten days to a fortnight after the expected but missed menstrual period was due, but it may occur much sooner. About this time a slight but continuous loss of blood from the vagina commences. In about a quarter of all eases there is no history of a missed period, owing to the bleeding from the vagina just mentioned commencing earlier and at the time the missed period was expected.
The shape of the chest alters a good deal. lt tends to become rather like a barrel, and a certain amount of wheezing is always present. The face as a rule is flushed and rather dusky and there is always breathlessness.
Patients with this complaint should if possible winter in a warm dry climate. Winter clothing should be warm and protective, but over-clothing of the chest and so-callel “chest protectors" are more harmful than helpful. Easterly and north-easterly winds, fog and very low temperatures aggravatc the condition, but an outdoor life should be led so far as weather conditions permit.
If any tendency to irritation of the chest shows itself a steam kettle should be kept boiling in the room and even maintained during the night. A spoonful of friar's balsam added to the water is often very useful. Further, the diet should be attended to, because many cases of emphysema are really due to errors in eating and drinking.
In the portion of lung here shown the air spaces are very large, with the effect of diminishing the quantity of blood exposed to aeration as compared with normal lung, in which the spaces are minute.
Emphysematous people should be very careful not to over-exert themselves. The injury to and the stretchind of their lungs throw a heavy weight on the heart, which must pump the blood theough these damaged organs. Thus there is not, usually much reserve power. Quiet walks are the ideal form of exercise. Dusty roads should be avoided, since dust is an irritant which tends to cause trouble in the bronchial tubes.