Case Study – Chronic Bronchitis
Client is a 52 year old man, suffering persistent cough, shortness of breath and wheezing. Symptoms have been getting progressively worse over the past two years. Recently has been diagnosed with chronic bronchitis. Cough is productive, sputum usually whitish or yellowish. Has only recently given up smoking two weeks ago, was a heavy smoker of 2 packs per day for most of his life. Feels as though his chest has got worse since giving up smoking as he spits up large amounts of dirty coloured sputum first thing in the morning. As a child he also suffered asthma.
Since the cough has started, fatigue has set in, finds it hard to wake in the morning and his energy levels throughout the day are at low. The client is unfit and spends a lot of time watching TV.
Current diet mostly consists of cooked breakfast from a cafe, meat pie or toasted sandwich for dinner, 5 coffees per day, 2L of cool drink per day and 2 glasses of water.
The client is suffering from chronic bronchitis with smoking likely a major contributing factor. Chronic bronchitis is a disease state that falls under the category of diseases known as chronic obstructive pulmonary disease (COPD), the two main diseases under the category are emphysema and chronic bronchitis. Chronic bronchitis affects the lining of the airway with constant irritation and inflammation. The continual irritation and inflammation causes the lining to thicken, bronchioles lose their shape and become clogged with mucous. The combination of these symptoms causes difficulty in breathing for affected individuals. Other common symptoms of COPD include fatigue, a productive cough and frequent upper respiratory tract infections.
The clients’ long history of being a heavy smoker is a major contributing factor in the presenting disease state. The fact that the client has now stopped smoking is the best single thing that he could do for himself. Evidence suggests that the rate of progression of COPD can be reduced significantly with the cessation of smoking. The sore chest and increased productivity of the cough since quitting smoking is normal shortly after quitting smoking as the body ramps up its detoxification and healing processes to remove built up congestion and repair the damage as best it can.
The clients’ diet is very poor and required a complete overhaul. A wholefoods balanced diet needed to be incorporated with balanced amounts of quality protein, fats and carbohydrates. Currently there is a lack of quality protein, healthy fats and next to no fresh fruit and vegetables in the diet. The diet advice excluded foods that have a known detrimental effect on the immune system. These foods include refined sugar, processed grains, fast foods, trans-fats, soft drink and caffeine. In addition, mucous forming foods such as dairy products including milk, cheese and ice-cream need to be avoided along with wheat based products. Water consumption required increasing from two glasses per day to eight glasses, assisting with the thinning of the mucous and general wellbeing.
The clients’ current level of activity needs to be improved. Exercise is shown to be a crucial part in managing the condition. Exercise can be difficult with COPD, a tailored exercise program to the current level of fitness is required, utilising breathing techniques such as pursed lips and having adequate rest periods to ensure the exercise level is not overdone are very important.
Since smoking has already been given up, the next major area to focus on is the diet. A balanced macronutrient ratio of 15-20% protein KJ, 30-40% fat KJ and 45-55% carbohydrate KJ was prescribed. Pro-inflammatory foods were removed and the addition of anti-inflammatory foods such as berries, small oily fish, nuts and seeds, turmeric, olive oil, ginger and green tea were now included in the diet. Foods such as garlic and onion are beneficial for their mucolytic action while the introduction of fermented foods and probiotic foods such as sauerkraut and yoghurt will benefit the gut health and overall immune function.
Immune function, lung function and muscle strength are of vital importance in treating COPD. A diet high in antioxidants and vitamins such as A, C and E along with the minerals such as zinc, selenium and magnesium are required to assist the body in functioning efficiently.
Vitamin A has specific healing effects on the respiratory system through the preservation of the mucous membranes and lung epithelium as well as its anti-inflammatory effect. Vitamin C is an immune modulator and an antioxidant and is known to improve lung function. In addition, bioflavonoids such as quercetin are indicated for the enhancing properties on vitamin C and their supporting nature on the immune system and reduction in inflammation. Selenium is a known antioxidant and assists in the defence against oxidative lung damage while zinc assists in many areas such as tissue repair and immunity.
Omega 3 essential fatty acids (EFA) are indicated in the treatment of COPD. Omega 3 EFA’s exhibit anti-inflammatory effects on the body and exhibit a protective mechanism on the body when consumed, particularly with chronic inflammatory conditions such as COPD. Magnesium is a known bronchodilator, helping reduce bronchospasm and stress while supporting energy production.
NAC has been shown to be effective in the treatment and management of COPD. A meta-analysis of 13 studies involving 4155 COPD patients treated with NAC showed that patients significantly and consistently had fewer exacerbations of chronic bronchitis. Another beneficial supplement would be Coenzyme Q10, CoQ10 is involved in the electron transfer in the inner mitochondrial membrane and may assist muscular energy metabolism. A study conducted for 8 weeks on COPD patients found that with supplementation of 90mg of CoQ10 energy metabolism was increased assisting with hypoxemia during exercise and rest.
Herbal medicine will benefit this case and was prescribed. Herbal actions sought were expectorants and demulcents to assist with the removal of sputum and help soothe and restore the mucous membranes and lining of the lungs and trachea. Anti-inflammatories, bronchodilation herbs and immune enhancing herbs were also included.
Other areas that were discussed were the reduction of any chemical and environmental irritants that may increase the bronchospasms. Things such as household chemicals, second-hand smoke, petrol fumes etc. can all irritate the condition.
|Vitamin C||Immune function, anti-inflammatory|
|Vitamin A||Tone and repair mucous membrane, immune support|
|Zinc||Mucous membrane and immune support|
|Magnesium||Reduce bronchospasm, stress response, increase energy production|
|NAC||Reduce symptoms, bronchospasm etc.|
|Co Q 10||Support heart and lung function, antioxidant, optimise oxygen usage|
|Herbal||Support lung function|
|Exercise||Increase lung function / stress management|
After 12 weeks of the modified diet and lifestyle, nutritional supplements and herbal protocol, the client’s symptoms had improved considerably. COPD is a long term chronic condition that is often irreversible however lung function and energy levels have been continually rising over this period. The client could breathe much easier and exercise had increased, the client felt that sputum clogging up the airways was no longer apparent.