Chronic bronchitis, emphysema, airway obstruction, and recommendations for driving

Chronic bronchitis, emphysema, airway obstruction, and recommendations for driving Chronic bronchitis, emphysema, airway obstruction, and recommendations for driving

Chronic bronchitis is characterized by cough and tracheobronchial mucus expectoration for at least three months a year, and for two consecutive years.

Chronic asthmatic bronchitis is associated with cough, mucus expectoration, dyspnea and wheezing, in the context of acute respiratory infections or inhalation of irritant substances.

Emphysema is characterized by distention of the respiratory spaces, distal to the terminal bronchioles and with alveolar wall destruction.

Chronic obstructive pulmonary disease (COPD) is a condition characterized by chronic obstruction of the expiratory flow, due to chronic bronchitis and/or emphysema.

The predominance of emphysema is seen in a patient of asthenic build that show tachypnea, prolonged expiration, and dyspnea on effort with limited expectoration.

It progresses to cor pulmonale and respiratory failure.

The predominance of bronchitis is related to patients usually with overweight, and suffer cyanosis, cough, and chronic expectoration.

Dyspnea is less severe and edema is frequent.

Episodes of respiratory failure recovering with the appropriate treatment are very common.

The treatment is aimed at preventing and treating the reversible airway obstruction.

These patients require regular follow-ups during worsenings and out of them, assessing respiratory function to adjust the treatment and prevent complications.

Although COPD is progressive, its worsening is accelerated by smoking, and by occupational products and factors that can aggravate the disease.

Bronchodilators such as methylxanthines, sympathicomimetics and anticholinergics can relieve the symptoms.

Beta2-selective drugs such as salbutamol and metoproterenol in controlled dose inhalers are those which fewest side effects.

The anticholinergic ipratropium in controlled dose inhaler is among the best bronchodilators for patients with COPD.

Glucocorticoids should be used when the other measures are not sufficient, verifying the clinical improvement they bring and seeking the lowest effective dose.

In case of severe hypoxia and/or cor pulmonale, continuous oxygen therapy should be administered.

Recommendation

  • As driving is not an activity of effort, patients with chronic uncomplicated bronchitis and emphysema can drive.
  • The appearance of transient dyspnea by respiratory infection prevents from driving until the condition subsides completely.
  • As bronchitis frequently expectorates, it is easy that while driving the patient must take a handkerchief to place the sputum, which involves a distraction from the road, and increases the risk of having an accident.
  • Furthermore, during the expectoration process, the patient uses one or both hands for this maneuver, which means leaving the steering wheel in part or completely, eventually increasing exponentially the risk of accident.
  • We should recommend these patients to carry out short travels when driving, doing all stops in safe place, to expectorate without running risks.
  • Coughing fits block the driver preventing him from controlling the environment and being able to cause an accident.
  • If the cough is in addition productive it involves more distraction and loss of control of the circulation and the car.
  • We should recommend patients that, in very consecutive coughing fits, they should not drive for their safety and that of the others.
  • Patients on continuous oxygen therapy and stable disease want to drive in order not to lose their independence or freedom.
  • Since patients who can walk with their oxygen bagpack wanting to drive place it in the seat of the companion and remain joined to it through the oxygen therapy glasses.
  • Any sharp movement while driving can lead to lose connection and make the oxygen bagpack impact in any direction with the attendant anxiety for the hypoxic driver in this situation.
  • Some drivers chronically dependent on oxygen do not accept stopping driving and place an oxygen bullet on the floor or back seat hardly held, connected to it through oxygen therapy glasses.
  • Any displacement of the cylinder while driving can pull off or take off the glasses and distract or displace the driver until he can stop the car and restore the inadequate sensation.
  • It is advisable to ask about the possibility of adapting the car to oxygen entry in order to drive safely.
  • Most of these patients suffer COPD because of smoking. Smoking is not only a physical distraction, but it also reduces the capacity to drive due to the high levels of carbon monoxide inside the car.
  • The limitation caused by smoking in drivers with COPD joins to other side effects of smoking in the car, raising the risks for these drivers, as well as the darkening caused by smoke on the front windshields.
  • Smoke interferes with the ability of the eyes, particularly for adaptation needed when entering or leaving a tunnel.
  • The necessary distractions of smoking in the car, such as lighting up and putting of the cigarette, holding it by the fingers and removing the ashes, amongst others, prevents the driver from concentrating on driving.
  • The CO increase causes dizziness, lack of concentration and attention, headache, dulling and can reach loss of conscience.
  • In addition to recommending our patients to quit smoking in order not to die from their disease, they must be reminded that they are more susceptible to the CO held inside the car, as they usually suffer hypoxia for the disease itself.
  • Perhaps because these patients obtain the greatest benefit from a smoke-free environment, we can recommend them to seek it at home and in their car, since if those around them continue smoking, they can hardly isolate from smoking.
  • A good method for it is to establish a smoke-free area in the car itself, so that in the same way as they get away from smoking, they avoid that children and other relatives are involved in it.

Advice on Chronic bronchitis, emphysema and airway obstruction

  • As driving is not an activity of effort, patients with chronic uncomplicated bronchitis and emphysema can drive.
  • The appearance of transient dyspnea by respiratory infection prevents from driving until the condition subsides completely.
  • As bronchitis frequently expectorates, it is easy that while driving the patient must take a handkerchief to place the sputum, which involves a distraction from the road, and increases the risk of having an accident.
  • Furthermore, during the expectoration process, the patient uses one or both hands for this maneuver, which means leaving the steering wheel in part or completely, eventually increasing exponentially the risk of accident.
  • We should recommend these patients to carry out short travels when driving, doing all stops in safe place, to expectorate without running risks.
  • Coughing fits block the driver preventing him from controlling the environment and being able to cause an accident.
  • If the cough is in addition productive it involves more distraction and loss of control of the circulation and the car.
  • We should recommend patients that, in very consecutive coughing fits, they should not drive for their safety and that of the others.
  • Patients on continuous oxygen therapy and stable disease want to drive in order not to lose their independence or freedom.
  • Since patients who can walk with their oxygen bagpack wanting to drive place it in the seat of the companion and remain joined to it through the oxygen therapy glasses.
  • Any sharp movement while driving can lead to lose connection and make the oxygen bagpack impact in any direction with the attendant anxiety for the hypoxic driver in this situation.
  • Some drivers chronically dependent on oxygen do not accept stopping driving and place an oxygen bullet on the floor or back seat hardly held, connected to it through oxygen therapy glasses.
  • Any displacement of the cylinder while driving can pull off or take off the glasses and distract or displace the driver until he can stop the car and restore the inadequate sensation.
  • It is advisable to ask about the possibility of adapting the car to oxygen entry in order to drive safely.
  • Most of these patients suffer COPD because of smoking. Smoking is not only a physical distraction, but it also reduces the capacity to drive due to the high levels of carbon monoxide inside the car.
  • The limitation caused by smoking in drivers with COPD joins to other side effects of smoking in the car, raising the risks for these drivers, as well as the darkening caused by smoke on the front windshields.
  • Smoke interferes with the ability of the eyes, particularly for adaptation needed when entering or leaving a tunnel.
  • The necessary distractions of smoking in the car, such as lighting up and putting of the cigarette, holding it by the fingers and removing the ashes, amongst others, prevents the driver from concentrating on driving.
  • The CO increase causes dizziness, lack of concentration and attention, headache, dulling and can reach loss of conscience.
  • In addition to recommending our patients to quit smoking in order not to die from their disease, they must be reminded that they are more susceptible to the CO held inside the car, as they usually suffer hypoxia for the disease itself.
  • Perhaps because these patients obtain the greatest benefit from a smoke-free environment, we can recommend them to seek it at home and in their car, since if those around them continue smoking, they can hardly isolate from smoking.
  • A good method for it is to establish a smoke-free area in the car itself, so that in the same way as they get away from smoking, they avoid that children and other relatives are involved in it.