Breathing disease on the rise, linked to smoking
DANBURY, Conn. -- After a while, Charles Stone couldn't golf anymore.
"If I took a practice swing, I'd be too out of breath to actually hit the ball," he said.
Stone, 79, lives in Redding. He led a full and active life until the 1980s when emphysema robbed him of most of his capacity to breathe. He is now tethered to an oxygen tank, all the time.
"I can get around," he said. "I can drive any place I want. I can walk at the mall. But we have to plan any place we go, so I can bring a small oxygen tank with me. Luckily, I have a very tolerant wife."
Stone was a smoker for nearly 50 years. Philip Brockelman of New Fairfield put in 31 years of two packs a day. Like Stone, he's now on oxygen.
"What happened to me?" he said. "Smoking. I was getting so winded, I'd have to think about what I had to do every time I walked upstairs."
In an era when occurrences of heart disease and cancer are in decline, Stone and Brockelman suffer from one affliction that's on the rise - chronic obstructive pulmonary disease, or COPD.
COPD is an umbrella term that includes both chronic bronchitis - "smokers cough" - and emphysema. About 14 million Americans suffer from chronic bronchitis, and another 2 million from emphysema. Some doctors believe another 14 million Americans suffer from COPD but are undiagnosed. The disease is more prevalent, if less noticed, than asthma.
COPD is the fourth-leading killer in the United States, behind heart disease, cancer and stroke. More than 100,000 Americans die of it each year, and another 500,000 need hospitalization every year because of it. It's the second leading cause of disability in the United States, and costs the nation more than $30 billion in medical expenses each year.
Because fewer women are quitting smoking, rates on women dying of COPD are rising. In 1992, according to the National Lung Health Education Program, 41,000 women died of COPD; by 1997, that figure was up to about 53,000.
"It's one of the few causes of death that's rising," said Dr. William Bailey, professor of medicine at the University of Alabama at Birmingham, and director of the university's Lung Health Center.
It's a highly preventable disease. Cigarette smoking causes 80 to 90 percent of all COPD cases; about 15 to 20 percent of smokers develop COPD.
"In fact, if you look at all four of the top diseases in the country - heart disease, cancer, stroke, and COPD - every one of them is tobacco-related," Bailey said.
Up to a certain point, people can reverse the progress of COPD by quitting smoking. The ongoing National Lung Health Study has shown that people with COPD who give up cigarettes can improve their lung capacity, Bailey said.
Doctors also have learned that exercise and nutrition can help people with COPD lead better lives.
There are also several drugs available to help COPD sufferers regain some lung capacity. One of the most promising is Spiriva, developed by Boehringer Ingelheim, the pharmaceutical company that has its corporate offices in Ridgefield.
Spiriva is an inhaled drug that opens the airways. It's the first to offer once-a-day treatment for COPD. Studies have shown Spiriva to be more efficient in improving lung function than other drug therapies; it is also expected to be less expensive, costing about $2 a day.
While chronic bronchitis and emphysema may seem to be separate diseases, clinicians have considered chronic bronchitis and emphysema part of a continuous disease for years.
"It's a progressive disease," said Dr. Arthur Kotch, a pulmonologist at Danbury Hospital.
It starts with chronic bronchitis.
"People who smoke don't get themselves checked because they think what they have is just part of smokers cough," said Bailey of the University of Alabama.
In the early stages of the disease, cigarette smoke stimulates the lungs to produce mucus, and thickens the walls of the bronchi, the large airways into the lungs, as well as the bronchioles, the smaller airways. People are diagnosed as having chronic bronchitis when they cough up sputum most days for at least three consecutive months in at least two consecutive years.
After several years of damage, the small airways in the lungs become scarred and inflamed, and the smooth muscles in the lungs can spasm. While that inflammation damages the bronchioles, some of this damage can be reversed.
In emphysema, the alveoli - the tiny, balloon-like sacs at the end of the airways in the lungs - become damaged, bursting and blending to create larger sacs with less surface area and, hence, less lung capacity. This damage also means the bronchioles have no structural support, and collapse when a person exhales, making breathing difficult, and robbing the blood of oxygen. This damage is permanent. The whole body also suffers from lack of oxygen in the blood.
Today, medicine is taking steps to at least retard the progress of COPD. Portable oxygen tanks let people go out in public; exercise helps people maintain the lung and heart function they have; and drugs are increasing their ability to breathe better. Kotch said there are also treatments being tested to reverse the damage in emphysema.
"That's something I always felt I'd never see in my lifetime," he said.
Remarkable improvements can be seen if smokers quit, Bailey said.
"It used to be considered untreatable, but that's not so," he said.
"Were seeing an improvement in the quality of life," Kotch said. "That's what's important."