Monday, April 23, 2012

1941: Dr. Christie defines emphysema and how to treat it

Ronald V. Christie was considered to be the most renowned expert on emphysema in the 1930s and 1940s.  He defined the disease pretty much as we know it today, and then he provided various treatment recommendations that he determined would help these patients during episodes of acute dyspnea.

In his article "Emphysema of the lungs:  part II," (British Medical Journal, Jan. 29, 1944, pages 143-146) he describes how ephedrine was the best medicine to relieve dyspnea.  He noted the following:

"Although there may be no evidence of bronchospasm or resistance to respiration, the administration of ephedrine not infrequently relieves the dyspnoea of emphysema.  A possible explanation of this effect is that the bronchioles leading to the over-distended air sacs and bullae are less capable of changes in calibre than those leading to healthier parts of the lung; bronchospasm, although not clinically manifest, would in this case increase the proportion of the inspired air deflected to these useless parts of the lung, and the relief of bronchospasm with ephedrine would improve the efficiency of ventilation and thus relieve dyspnoea."
It's interesting that he wrote this considering I have often wondered myself why a bronchodilator would benefit emphysema patients.  It's not like a bronchodilator would help a patient regrow lung tissue.  Yet what he wrote makes sense, and other more recent studies have confirmed what he suggested (sort of).

He briefly mentioned surgical procedures to deflate parts of the lungs.  He was also among the first to describe "respiratory exercises designed to teach the patient to deflate the lung and to increase the use of the diaphragm."

During the end stages of the disease when heart failure occurs he recommends oxygen.  Back then oxygen tanks had to be hauled into the hospital room by the nurse.  He explained that "recovery from heart failure in emphysema was uncommon."  However, he explained a case in which supplemental oxygen could extend the life of a "moribund" patient for a little while.