Inhaler won’t stop my emphysema coughing bouts

Q I was diagnosed with emphysema a few years ago. I understood it was caused by smoking, which I’d done since being a teenager. I managed to give up in the pandemic, but I still frequently have coughing bouts and get really short of breath, especially doing any exercise and even climbing stairs. My blue inhaler helps a bit, but is there anything else that would ease my breathing and especially the coughing?

A In emphysema, the walls of the small air sacs in the lungs are damaged and they break down, leading to larger air spaces instead of lots of small ones.

This reduces the overall surface area where oxygen in the air can be absorbed into the bloodstream, which leads to shortness of breath, especially with any type of exercise.

It’s a long-term condition that usually progresses over several years. And though, occasionally, it’s caused by an inherited defect in the lungs’ lining, by far the most common case is smoking.

The longer and more you have smoked, the greater the risk.

Many people with emphysema caused by smoking also have long term inflammation in the tubes (bronchi) that carry air into the lungs. Known as chronic bronchitis, this leads to a persistent cough, often with creamy coloured phlegm.

Unfortunately there is no cure for either condition, but you have already taken the most important step in slowing down their progression, which is to stop smoking.

The blue inhaler you have can widen the airways on a short-term basis, but you may find it helpful to have one that lasts longer.

There are several different types, containing drugs such as salmeterol or tiotropium. Steroid inhalers are also sometimes used to reduce inflammation. Pulmonary rehabilitation can also be very helpful.

It’s a specialised programme of exercise and education that can improve how much you can do before you feel short of breath, and also improve your general health and emotional wellbeing.

Your GP will be able to help with all of these treatments.

Q I’ve had a few episodes recently when my vision has been really weird, as if I’m looking through a series of bright, blurry lights.

It lasts about half an hour and then my sight goes back to normal, although on a couple of occasions I’ve had a bit of a headache as well.

Should I get my blood pressure checked? I’m aware I’ve been a bit stressed recently as my mortgage payments have shot up, but otherwise I can’t think why this is happening.

A This could be a condition known as kaleidoscope vision, where the images you see are disjointed and brightly coloured as if you are looking through a kaleidoscope. It may occur in one or both eyes or on just one side of your vision, lasting usually between 10 to 30 minutes, although it can last up to an hour.

Occasionally, in older people, it can be a sign of an interruption to the blood supply to the brain (a mini stroke) and for this reason it is important that anyone having kaleidoscope vision is seen by a doctor. The most common cause is migraine, and although a headache may follow the visual changes, in some only the sight changes occur – a condition known as ocular migraine. The best way of tackling this is to try to prevent the attacks occurring. As with other forms of migraine, this is best done by keeping a diary to try to identify possible triggers, such as foods (chocolate and red wine are common culprits), stress or becoming overtired.

As most attacks of kaleidoscope vision are quite short there is usually little benefit in medication such as triptans used to lessen the symptoms of migraine headaches.

But if you have frequent attacks then preventative medicines such as beta or calcium channel blockers may be helpful.

Q I’ve been on HRT for a couple of years. Though it helped with my flushes and sweats, it didn’t help with my non-existent libido – so my GP prescribed testosterone gel a couple of months ago. So far it’s not made any difference, but I’m getting what looks like acne where I put it on my arm. I’m thinking of giving it up. Is there anything else I could try?

A Testosterone gel has been shown to improve libido in about 50 per cent of women along with HRT, but it can take up to three months to be effective. So give it a bit longer before assuming it isn’t working.

Unfortunately side-effects can include greasy skin, acne and increased hair growth, but these can usually be minimised by applying the gel to a different part of the skin each day. It’s also important to check how much gel you are using.

Products available in the UK are all designed for men with testosterone deficiency and women only need a fraction of their dose so it can be easy to accidentally use too much.

Check with your GP exactly how much you should be using and, if you find it hard to use the right amount, ask about a different formulation. Although low libido can often occur when hormone levels drop after the menopause, there are lifestyle factors that can also contribute to the problem.

Many women around 50 are juggling work and running a home with looking after teenage offspring and parents growing old and infirm.

So it’s no wonder that when you finally get into bed at the end of a long day its sleep, rather than sex, that is the priority.

Tackling these lifestyle issues can be difficult, but asking for more help around the house and making some time for yourself could make a difference to how you feel.

● If you have a health question for Dr Leonard, email her in confidence at yourhealth@express.co.uk. She regrets she cannot enter into personal correspondence or reply to everyone