Your Health Questions: How can I control mucus level with COPD?

Q: I would appreciate information re COPD. I have had lung damage from smoking and another severe lung condition. Currently I don't take medication and the condition is controlled by diet, by avoidance of mucus-forming drinks and food. What medication is available to treat COPD which is effective in controlling and /or alleviating the mucus deposit in the lungs? - Terry

Dr Sarah Jarvis replies: Chronic obstructive pulmonary disease (COPD) used to be called chronic bronchitis or emphysema - it's sort of a combination of the two. The most common cause in the UK is smoking, although some people with an inherited shortage of a chemical called alpha-1 antitrypsin can get COPD even if they've never smoked.

The small airways in the lungs are usually kept open by 'septae' which surround them like spokes in a bicycle wheel and act as springs to pull them open. In COPD, these septae are destroyed and the small airways collapse, causing trapping of air and less efficient transfer of oxygen from the lungs to the bloodstream. Damage to the airways also causes excess secretion of mucus from cells in the walls of the airways, called goblet cells. This mucus is hard to get out and can block the airways as well as providing a perfect place for bacteria to multiply. People used to be diagnosed with chronic bronchitis if their main problem was producing lots of mucus and coughing.

In asthma, the airways also become narrowed, causing the same shortness of breath and wheezing seen in COPD. A major difference between asthma and COPD is that the airways narrowing in asthma is completely reversible, so many people with asthma have completely normal lung function when their symptoms are controlled. In fact, there are lots of world-class athletes with asthma. In people who have severe or poorly controlled asthma for a long time, the changes in the lungs start to become irreversible, so they can develop COPD as well.

COPD is thought to affect up to one in seven people aged over 35 in the UK - about 3.5 million people - but under a million of them have been formally diagnosed. That's partly because smokers don't seek help, assuming their breathlessness and chronic cough is a 'normal' consequence of smoking. But even at an early stage, there's lots that can be done. Stopping smoking is absolutely key - while it doesn't reverse the changes in the lungs, it can dramatically slow the rate at which symptoms get worse. Getting a regular flu vaccine and a vaccine against pneumococcal disease will reduce the chance of infection settling on the lungs, causing serious infection.

In terms of drug treatments for COPD, the evidence suggests that regardless of what your main symptoms are (in your case, mucus) the mainstay of treatment should be inhalers. There are two main kinds of 'reliever' inhalers - beta agonists (including salbutamol, used to relieve asthma symptoms) and muscarinic antagonists. Because symptoms of COPD don't change as fast as those of asthma, most people are started early on 'long-acting' relievers, which last for 12-24 hours. In more severe cases of COPD, a tablet called carbocisteine is sometimes added specifically to reduce mucus production. However, on their own, these aren't as effective as inhaled medicine.

Please consult a doctor or other health care professional if you have health concerns or for diagnosis and treatment of medical conditions.