Coughing and difficulty in breathing

Problems and possible causes

Respiratory problems, particularly lung infections, are common in people with AIDS and can be quite serious. The most common symptoms are chronic cough, shortness of breath, chest pains, and increased production of mucus (also called sputum).

The most common causes of respiratory problems include:

· colds and flu
· bronchitis
· pneumonia
· tuberculosis (see Chapter Six)
· heart problems.

What to do at home

People should be made aware of the signs and symptoms that are of concern, including:

· the onset of a fever or a change in the regular fever pattern of the sick person
· blood in the sputum
· a sudden or rapid worsening in their ability to breathe or catch their breath after normal activity
· a change in the colour of their sputum from clear to grey, yellow or green.

The following advice may help to decrease respiratory problems.

· Keeping active by walking about, turning in bed and sitting up. This encourages the lungs to drain.

· Other measures which encourage drainage of the lungs include massage or gentle patting on the back of the chest over the lungs. Someone in the home can do this, especially for younger children.

· If pain is felt in the chest or ribs during coughing, a pillow or hand should be held tightly over the area that hurts when coughing. This helps make the cough less painful.

· During the day it may be beneficial to cough and clear the lungs at least four times a day. Even though coughing may cause discomfort, it is an important way to clean the lungs of the accumulated mucus and disease-causing bacteria.

Thus, anyone with lung problems should be encouraged to cough. Several points are worth mentioning:

· The bacteria or infectious agents in the sick person's sputum can be passed to other people through the air, especially when coughing. When anyone is coughing, they should always cover their mouth with their hand or with a cloth which can be cleaned or disposed of.

· All homes and other places where people meet should be ventilated - make sure there is a way in and a way out for fresh air.

· An irritating cough can sometimes be relieved with safe cough remedies, for example:

- Soothe the throat by drinking tea with sugar or honey.

- Use a safe, home-made cough syrup. Throughout the world families and herbalists have suggestions for things that soothe coughs.

- Commercial remedies may also be useful although they are often expensive and usually work no better than home remedies.

· A constant cough can be very tiring and interfere with a person's rest. If coughing keeps someone from being able to sleep at night a cough suppressant can be prescribed. It is important to cough, so do not encourage the use of cough suppressants during the day. They should only be used at night to allow someone to rest.

Pain in the chest without signs of infection, and difficulty in breathing, are common problems in people with AIDS. Very often the cause is not known. Warm compresses to the area where the discomfort seems to be centred may be helpful. Additional hints are provided in this chapter under the section on pain. Medicines like aspirin or paracetamol may be useful at times. Paracetamol is safer for children. The dosages are described in the section on medicines for pain in Chapter Seven. It is important that the things done to help relieve the pain will also help someone in their efforts to keep active, moving and coughing.

When someone is experiencing difficulty in breathing the following advice might help:

· Lie with pillows under the head, or with the head of the bed raised on blocks.
· Sit leaning forward with the elbows on the knees or on a low table.

· Have someone else there. Difficulty in breathing can be very frightening.

In children with respiratory problems it is important to clear the nose if it is congested, and especially if the congestion interferes with the ability to eat or to be breast-fed. Dry or thick sticky mucus can be softened and removed with a wick moistened in salt water (a quarter of a teaspoonful in a cup of water).

Figure

If a lung infection with cough is present, it is important that plenty of fluids are drunk: first, to replace the extra fluids lost through the lungs by rapid breathing, and second to help keep the mucus in the lungs from becoming too dry and sticky and more difficult to cough out. Remind parents that fast or difficult breathing in children may be dangerous and needs medical treatment quickly.

Encourage children with respiratory problems to take more fluids by increasing the frequency of breast-feeding or by giving additional fluids by spoon or cup.

If the problems experienced with coughing, chest pain, or other respiratory symptoms are chronic (lasting more than three weeks) and do not respond to antibiotic treatment, tuberculosis may be the cause and should always be considered (see Chapter Six).

When sick people and their families must seek help

You should advise people to seek help if the sick person has a cough or difficulty in breathing and:

· sudden high fever develops

· they are in severe pain or discomfort

· the colour of the sputum changes to grey, yellow or green

· the sputum has blood in it

· they have had a cough for more than three weeks, especially if it also involves spitting up blood, pain in the chest or difficulty in breathing.

In children (particularly below the age of five) respiratory infections can be very serious. All children should be brought to a health care worker for immediate attention if they are:

· breathing with difficulty through the mouth or with audible wheezing
· breathing faster than usual
· unable to drink because of problems with breathing.

Notes on coughing and difficulty in breathing
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