Bronchitis

[Obs cop]

Hi all,

Just thought I would air my concerns relating to bronchitis. I am reluctant to air these in an official AME context as I have a class 1 and intend to retain it for some time.

Over the past 5 years or so I get a good solid weeks worth of severe bronchitis after every cold (doesn't even need to be flu). I obviously end up with no sleep for the duration, upset wife as she gets no sleep, and exercise etc. becomes difficult. I have spoken with my GP, who has informed me that there is nothing I can do to prevent these onsets, I'll just have to deal with them as and when they occur. The thing is they seem to be getting more frequent. Onset of one now (hence late typing hours!) and it is only 10 months since the last bout.

I can trace the history back to when I had a very severe bout in the navy some 10 years ago (Lasted for about 3 weeks and was very rough for about 5 days during that period). Ever since the bouts keep coming back although thankfully not as bad.

I consider myself a reasonably fit 30 year old who doesn't smoke, but does work shifts. My GP has eluded that my suseptibility may be down to having a very mild history of asthma ( parents smoke, wheezing after sever exercise, coughing bouts after laughter or coming in to warm air from cold) and that my lungs may just be more sensitive than most.

Is this a concern for my class 1? I have to say that when I flew over to the states last year, the aircraft airconditioning made me feel as if I was having real difficulty getting sufficient air into my lungs. It was quite nervewracking as I have previously flown hundreds of hours in pressurised aircraft including fast jets and been in pressure chambers without feeling any ill effects.

It all boils down to 3 questions...........

Is this a problem for retaining a class 1?

Is there anything that helps prevent the onset of the bronchitis?

What causes it?

Many thanks in anticipation

Obs cop

[Loose rivets]

Firstly, I’m a pilot, not a doctor.

Just to get something out of the way first. Has your GP given you a specific test for asthma? It does sound as though you have a tendency to react to specific stimuli. True bronchitis and asthmatic symptoms may become blurred and I feel that it is important to separate the problem into component parts. There are tests, but I don’t know if they cover all types of asthma.

If you have a tendency towards chronic bronchitis, then you would be well advised to make an assessment of your peak airflow while you are quite well. Do this every week, or even day…not just at the six monthly medical. Compare this with your peers and see if you are at least average. Use this as a datum. Poor peak flow would be an issue—if you were to attend a check while below par.

Is there an audible wheeze, when you are otherwise quite well? I.e. chronic.

Do you respond to antibiotics, but just don’t want to keep resorting to them?

Bronchitis in aircrew was given very serious consideration in our airline in the 60’s…it was endemic in the industry. But then so was smoking on the flight deck. Nowadays, getting a secondary infection (bacteriological) following a virus is often avoidable. It seems that the pipes are wide open to ‘bugs’ at the latter stages of a viral infection, so taking extreme care after a cold is vital. Simple precautions like keeping your distance from kids, pubs and coughing colleagues for a week or so can make all the difference. Just a few days more fending off the crewing officer!

Probably one of the most important bits of advice that I could give, is to get fresh air deep into your lungs. Forcing out the last dregs. This is in part what coughing is about. Of course, this is easier said than done if you have any tendency for your bronchi to clamp off as a reaction to cold air. But do persevere. If you sound like an old church organ, it doesn’t matter…get fresh air down there.

There is a lot of conflicting data on ‘stress and the immune system’ on the net, but the gist is, immediate and acute stress gives a boost to the immune system, but chronic stress causes a measurable decline in your defenses in the longer term. Concern over your health and license might just be adding fuel…I’m guessing.

Restricted breathing is very distressing, but don’t worry too much, some people that have had severe bronchitis circa 20 years old, have gone on to athletic prowess. These things tend to come in long term bouts, especially in a home with kids, but then disappearing for years. Working for an ‘we’ve got no one to replace you’ airline never helps.

[redsnail]

Gees, you could have been talking about me there!
I've got asthmatic tendencies and have just gotten over a mild does of bronchitis following a cold.
I didn't worry about seeing a doctor this time round as it went after a week. If the coughing lasts more than a week I cart myself off to the doctors and tell them the story. The smart ones check the peak flow and bung me on the Ventolin or if it's really not responding, a course of steroids to calm every thing down.
If you don't tell your doctor the full story then they'll just treat it as "bronchitis" and not manage the whole condition.

The doctor that made the initial diagnosis way back in 94 is also a DAME (aviation doctor). He said my version of asthmatic tendencies is not a limiting item on the medical so long as I take care of myself. Meaning, keep in reasonable condition, don't smoke etc.(Australian CASA)
The one question he asked that no other doctor had asked "have you ever had a bought of coughing that lasted more than a month for no apparent reason?" (ans, yes!)

He's Irish born and he recommended a session in the pub. His thoughts on modern cough medicines was hilarious. He reckoned that they are rubbish because the manufacturers took the alcohol out. He felt I needed a good night's sleep and a few beers would do that just fine. That was my prescription (along with the steroids).

I have been subscribing to that ever since :)

Good luck, see if you can find an enlightened doctor or tell the one you see all the time the whole history. They may be able to sort it from there. (I hold a class one in the UK too)

Your medical should be safe so long as you can pass the peak flow test and the coughing itself doesn't debilitate. I would see a doctor that isn't your aviation one and discuss a strategy. Asthma (however mild) is best managed rather than endured.

[767bill]

Hi Obs Cop,

Have similar condition to you. In fact I got my class 1 medical about a year ago, and not unexpectedly the peak flow test was the one where I struggled a little. Anyway, after being offered some on the spot coaching and allowed a couple more shots at it (didn't seem to make much difference to result..) I was passed on the basis of being borderline there but otherwise apparently OK.

So, answer is that there is some discretion and no doubt the rest of your health record will be relevant. (I'm sure it all deteriorates with age...including the required pass mark)

Believe the peak flow is so that your lungs would have the capacity to deal with sudden depressurisation at altitude, though do not know the details. Though it seems that if this happens in a small business jet at high altitude good peak flow still might not save you, do not know the phsiological / physical considerations in the case of an airliner.

All the best.

P.S. Following your IMC diary, nice one!

[tart1]

I don't know anything about how this problem relates to aircrew medicals. What I do know is that I had the same problem for some years before I started to regularly (twice a day) use a steroid inhaler (Flixotide) and for emergencies I have Bricanyl. I used to cough and wheeze every day - especially about an hour after getting up. I found it hard to do exercise and when I got a cold or flu I would be laid up for weeks with bronchitis. My life has been transformed. I am not happy using steroids permanently but the alternative is so bad that I put up with it. I am so much fitter now - I can exercise at a much higher level. I think that because I do not cough all the time that my lungs are in much better working order and I am not nearly so prone to going down with every cold and cough going. I am 46 and I was diagnosed 3 years ago with late-onset asthma which I think originated when I had pneumonia about 14 years ago. I do believe that managing the condition and keeping it under control is right thing to do.

[visibility3miles]

I am not a physician, but try using a humidifier (especially if the bouts of bronchitis occur in the winter, when the air is dry), as that will help cut down on colds, and use an air cleaner to remove pollen and mold particles that might aggravate your lungs.

[Obs cop]

Thanks all for the speedy and well composed responses.

My biggest concern really was if the bronchitis did relate at all to asthma then I feared for the worst. I'm off to see my GP tomorrow.

I don't really have any fear of the peak flow measurement as my current day job involves police firearms for which I need a decent level of fitness. My guess is that is the standard used to determine lung ability and so unless my next medical is on a "bronchitis" day I should be fine.

With the important concerns slightly allayed, I have to say living with this on an increasing regular basis really does p1ss me off something chronic (sic).

I'll let you know how I get on with the GP, suffice to say what the AME doesn't yet know is of little concern to them at the moment.
Redsnail,tart1 and 767bill, thanks for the personal stories element, it adds so much more to the hope it all goes well message.

Regards

Obs cop

[gingernut]

Obs cops, it does sound like your symptoms are relatively "mild," in terms of frequency, symptoms and severity.

Perhaps you could impress on your GP the importance of getting the diagnosis correct. As far as I Know, mild asthma shouldn't preclude a career in commercial aviation, but unfortunately, I aint an expert.

Perhaps he could label your symptoms, rather than your diagnosis, at this stage in his investigations. I wonder if a simple inhaler may help with your problem, prior to investigations?

Have a word with your practice nurse, they're perhaps a little more adept at managing problems simillar to yours, and they'll certainly be able to help with the diagnosis.


ps the treatments for conditions such as yours are very effective.

[Obs cop]

Gingernut,

Well done you read my mind.

Went to the GP today and now have a marvelous concoction of drugs to combat the bronchitis. It would appear that there is little that can easily be done to prevent the onsets of the bronchitis, but there is little to raise alarm bells about any long term impact on my lifestyle.

With regards to the asthmatic tendancies, I have to go back next week. I have never suffered from an asthma attack, so my "condition" is diagnosed as hyperreactive bronciols (spelling?). Basically if I laugh too hard I cough my guts up and likewise if I go running in the cold and then go indoors the same happens. The thing is at no point during the exercise is my breathing affected/restricted. Whilst this is a symptom of asthma, failing any other symptoms, we are just looking to treat what we know whic will be an inhaler for those moments when my lungs react to the changes in atmosphere.

I still don't know how this would affect a class 1 medical, my guess is not much, but at least my notes don't say I have been diagnosed with asthma. Unfortunately they do point to 3 bouts of acute bronchitis in the last 10 months. On checking back, I had bouts in Dec 03, March 04 and Dec 04. Ho hum.

Thanks all for the advice, I will report back after my next visit.

Just how much of this should I make my AME aware of?

Obs cop

[redsnail]

My view and I have pretty much the same condition as yourself is to let your AME find it. Ie so long as you test ok during each medical then I wouldn't divulge the info. After all, you're not "asthmatic" as such. Remember, people can hold class 1's with asthma, it just has to be effectively managed. It sounds like you're a long way from being medically threatened with asthma.

So long as you now have it treated effectively when it's active you'll probably find the rate of coughing decreases. You can ask your local doctor if s/he feels it ought to be reported. Personally (and I am not a doctor) I think not.

[gingernut]

Just how much of this should I make my AME aware of?

Certainly can't advocate telling untruths to the doc, but what I can say, is that the frequency, duration, and severity of your symptoms, sound to me, to be in the upper range of what I would consider "normal."

Have a look at threads like this (http://www.pprune.org/forums/showthread.php?s=&threadid=120927&highlight=inhaler)

good luck

[Rabid Dog]

Mmmm, they are some interesting opinions.
I'd ask my GP for a referral to a respiratory physician, and get it properly investigated and treated (if necessary).
To those of you that think that asthma is a mild, self-limiting disease, this isn't really the case - asthma kills - I've seen TOO many near-deaths to ever again ignore asthma, and always advise patient to religiously follow their asthma mangement plans.
As far as I know, you can't lose your Class 1 for having asthma, so long as it is correctly managed.
Good luck!
Send me a private message if you want to know some more.

[Obs cop]

Thanks for all the advice so far folks,

My medical is not until June, so I have a little time to play with. I certainly won't be telling any untruths to my AME, as I have not formally been diagnosed with asthma, I just find myself susceptible to bronchitis, changes of air temperature and coughing fits after a bout of laughter. At the moment, I'm more P1ssed off with the fact that after 10 days and a weeks worth of oral steroids (amongst other stuff), I still have the cough and it's worse than ever.

So far I have managed to pull a muscle in my neck through coughing and a couple of the bouts cause headaches at the back of my head with each couch. The headache is quite possibly due to the severity of the cough. Mind you, I had a mild pain behind my left eye after a coughing fit yesterday, which was very disconcerting. There was no associated vision problem, just the pain, which thankfully eased after 5 minutes or so.

Off to see the GP tomorrow, but why oh why can't I get rid of this thing? There's not even any phlegm to make it feel as if the cough is there for a reason.

Obs cop

[Loose rivets]

This sound very distressing. Further to my earlier comment, see what your doctor thinks about having O2 at home for a spell. It sounds a bit defeatist when you are young and active, but may only be needed for a while. Agin, deep down air. Bugs do not like it.

You have taken steps to reduce allergies I take it? Vac-ing the bed with a (Heppa Spelling?) Filtered cleaner, and keeping your distance from pets for a while etc. etc..