Today is the second day of the Chinese New Year, the year of the Ox. I was asked to see a case of abdominal pain in the Emergency Room. The patient developed upper abdominal pain about 4 hours after the traditional family re-union dinner on New Year’s Eve. The pain waxed and waned all night and was put down to indigestion from over-eating. Indigestion medication was tried but to no avail. Finally the pain was too persistent and intense and the patient attended the Emergency Room.

This reminded me of my days in England, where, on many Boxing Days, I was asked to see patients with upper abdominal pain. Invariably, the history would be the onset of upper abdominal pain a few hours after a sumptuous Christmas dinner. The pain would keep the patient up all night, was not significantly made better with antacids and finally the patient sought medical help in the Emergency Room.

In both cases, the patient was suffering from biliary colic or abdominal pain due to gallstones. The pain attack was brought on by the consumption of rich and oily food. (Roast turkey, sausages and cheese at Christmas dinner versus shark’s fin soup, multiple meat dishes, Chinese sausages and an assortment of cookies at Chinese New Year re-union dinner.) The gallbladder contains bile which is necessary for proper digestion of oily food. Thus, oily food stimulates the contraction of the gallbladder in order to deliver bile into the duodenum for the digestion of oily food. If you have gallstones in the gallbladder, contraction of the gallbladder against the stone(s) can give rise to pain. The rich food traditionally eaten at each festive occasion can and does precipitate an attack of pain from gallbladder contraction, called biliary colic.

Perhaps we should rename the colic episodes during these festive periods as ‘Festivity Colic’. To all Chinese readers, I wish you a Happy Chinese New Year.

People who live in areas with ‘bad air’ and smokers have an increased risk of developing chronic obstructive pulmonary disease (COPD). COPD affects over 600 million people worldwide and this represents about 10% of adults 40 years or older. In many Western countries, COPD is the leading cause of medical hospitalization. In 1990, COPD was the sixth most common cause of death worldwide. However, it is predicted that COPD will become the third most common cause by 2020.

As COPD patients have an underlying lung disease / injury, one would expect lung related conditions to be the main cause of morbidity and mortality. In the community, > 80% of COPD cases are mild to moderate COPDs [Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 1 and 2]. For these individuals, the leading cause of morbidity is actually cardiovascular disease (CVD) and not lung related problems. The leading cause of mortality COPDs is lung cancer (Curr Opin Pulm Med 2008; 14: 115 – 121).

Why is CVD more common if you have COPD? While the exact reasons are not known, two mechanisms have been postulated. An underlying neuro-humoral disturbance leads to excess sympathetic nervous activity. This raises the resting heart rate and increases the risk of arrhythmias (abnormal heart rate) as seen in COPD patients. Apart from lung inflammation, COPD patients also have evidence of systemic inflammation. Using C-reactive protein (CRP) level as a biomarker of inflammation, the Lung Health Study (LHS) examined the risk of all-cause and CVD mortality over 7 years of follow up in a COPD-specific cohort. The study found that, compared to the group with the lowest CRP level, the CVD mortality risk was 1.8 times higher for the highest CRP group. In the same study, the leading cause for hospitalization for this cohort of patients was CVD and the leading cause of mortality was lung cancer. Nearly half of all hospitalizations and 22% of all deaths were due to CVD. Lung cancer accounted for 33% of all deaths. Interestingly, only 8% of this study population died from respiratory failure.

In general, COPD is associated with an increased risk of lung cancer. Mild COPD (Gold stage 1) is associated with a 50% increase, moderate COPD (GOLD stage 2) 2.1 fold increase and severe COPD 2.7 fold increase, independent of the effects of smoking. Smoking further amplifies this risk and smoking cessation reduces this risk. However, smoking cessation never returns the risk to that of non-COPD subjects. Even if you have never smoked but you have developed COPD, your risk of lung cancer death is increased by 2.4 fold.

The race to being ‘developed’ has brought with it increased industrialisation, increased construction and increased consumption. In developed countries, the societal desire to stay ahead means ever more construction and consumption. Unfortunately, the inevitable consequence of all these activities is air pollution. As an individual, if you live in an environment with persistent air pollution, you are not able to stop these polluting activites around you. However, you can at least help yourself by not smoking. A small but worthwhile consolation.

No doubt many of you know what Vicks VapoRub is. Most likely you have used it to soothe your chest when you have a cough or cold. A common sight would be a parent rubbing a bit of VapoRub onto the chest of a child who is suffering from a stuffy nose and cough. I was therefore intrigued by an article entitled ‘Vicks VapoRub induces mucin secretion, decreases ciliary beat frequency, and increases tracheal mucus transport in the ferret trachea’ (Chest 2009; 135: 143 – 148).

Paediatricians from Wake Forest University School of Medicine in North Carolina, USA recently had to treat an 18-month old girl who developed severe respiratory distress after Vicks VapoRub was applied directly under her nose. Consequently, they decided to perform some experiments on healthy ferrets to investigate the effect of Vicks VapoRub on mucin secretion by the trachea. Trachea specimens were incubated with or without Vicks VapoRub in culture plates. They found that mucin secretion by trachea cultured with Vicks VapoRub was increased by 63%. They concluded that their findings were similar to the acute inflammatory stimulation observed with exposure to irritants. This irritation leads to increased mucus secretion which then obstructs small airways and increases nasal resistance. The authors saw a further two cases of respiratory distress in toddlers who had used Vicks VapoRub. The senior author of the research paper recommends not putting Vicks in or under the nose of a child or adult.

I have no doubt that many thousands of parents have used Vicks VapoRub on their children to soothe their symptoms of chest congestion. How many have had severe respiratory symptoms because of its use is unknown. Could these 3 cases be an idiosyncratic response to Vicks? Or could the respiratory distress be a response to too mcuh Vicks being placed into the nose? This report is unlikely to stop people from using Vicks VapoRub on their children. What this report can do is to raise public awareness that Vicks VapoRub can induce severe breathing difficulty in some.