What is emphysema?

Crawdad (The Silver)
Crawdad (The Silver)

November 13th, 2002, 1:08 pm #21

It was my doctor telling me I have emphysema that finally got me off my butt and quitting. My paternal grandfather died of E in his early fifties. My dad was scared to death that he had E and would die like his dad did, and quit when he was 35.

It was rather cold the way they told me I had it. After a yearly physical including blood work and chest X-rays the doc's nurse calls me up a few days later. "your cholesterol is high. your red blood cell count is high - thats from smoking. your liver enzymes are good. Oh, and by the way, the radiologist reading your Xrays has determined you have emphysema."

Well. From the way the message was delivered one would think "Ah, no big deal. Hemmoroihds, tonsillitis." Well, no. A bit of research on the web brings up word like irreversible, progressive, and fatal.

So I called my doc back and said "Tell me about this diagnosis" He says "It's really no surprise, given that you've smoked 2 packs a day for 30 years." I say "What now ?" He says "Well, you can keep smoking and in 5-8 years you'll be on oxygen 24-7, or you can quit now and it won't get any worse."

I'm not in that bad shape now. I can charge around our oversized block, with fairly significant hills, with my wife who has never smoked and not be any more out of breath than she is.

We had an extended damp period a week or so ago, and I noticed the slightest shortness of breath at rest then. That scared the ****** out of me. The weather dried out and things returned to normal.

Last week I had an appointment and "bragged" to my doc that I had quit for six weeks and was planning on staying that way forever and what could I/he/we do to keep the E from getting worse ? So he gave me Advair, which is a combination bronchodialator and steroid in inhalable powder form. My research on the web indicates that it is typically prescribed for asthma sufferers, but it can certainly help with E as well.

So far, so good. As the weather has stayed dry since getting the script I can't say for sure that the advair is for sure the thing that is doing the trick, but it has been better.

What I've found from researching E on the web : Bottom line : if you live long enough you will get emphysema. It's part of the natural deterioration of the body with age.

Smoking causes onset at a much earlier age. Much earlier. And once you have onset continued smoking accelerates the progress.

If you have onset and quit, it is my understanding that progress of the disease continues from there at the normal aging rate. That's what my doc tells me, and that's what I'm banking on.
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Anastazia(Green)
Anastazia(Green)

November 26th, 2002, 7:46 am #22

This is part of message number 9 pasted. I have a question that I hope somebody can answer for me. I spent quite a bit of time last night cruusing the internet looking for more information on COPD. I didn't find anything that specifically addresses this part. And I do admit I did get a bit sidetracked looking at other aspects. The part I am curious about is the part I bolded. Does this mean that with emphysema you can get more lung function back?

Thank you for any answers.

"Zep, being a nurse who works with the elderly patients, a lot of them with COPD which includes emphysema and asthma, who continually need respiratory treatments. I see respiratory techs all the time...and after I was told that I had beginning emphysema, I have questioned all of the techs...this is what they tell me in short... the parts of the lungs that are dead will never recover...but the tissue in the lungs that is a sleep, (meaning coated) will wake up when the damaging sorce is stopped being put into the lungs....this is not a progressive disease unless you continue to put into the lungs the sorce that is doing the damage...sorces include smoking, chemicals, etc....."
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Joel
Joel

November 26th, 2002, 10:40 pm #23

Hello Anastazia:

The underlying lung tissue which is destroyed cannot regenerate. In a sense then, the loss of lung elasticity cannot come back. But the lining tissue of the wind pipe does regenerate. This tissue, primarily the Cilia is key to sweeping out the lungs, keeping the airways open and making breathing easier. So by this tissue being repaired, even though you don't get back the lungs elasticity, it keeps the airways cleaner and makes it easier for the remaining lung tissue to work without small airway obstructions. Added to this is the bonus of the blood's ability to carry much larger amounts of oxygen than when poisoned by carbon monoxide from tobacco smoke. Again, the lungs as well as the heart's workload is decreased when the blood carries the extra oxygen.

See articles:
Smoking's Impact on the Lungs
Smoking and Circulation
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John (Gold)
John (Gold)

November 27th, 2002, 1:46 am #24

Anastazia, I saw this post yesterday and spent a bit of time before bed exploring the question you raised in the highlighted portion. I think you have the same question that I've had all along with the subject of emphysema. As Joel says, clearly those alveoli (air sacs), among that 300 million that we started with in each lung, that have been destroyed will remain destroyed. But, in talking about emphysema being a "progressive" disease, does it remain progressive even after we quit smoking?



Although you'll find some research in the area of regeneration, I don't think you'll find any info at those sites suggesting that there is any hope of ever regenerating any dead alveolus - the research appears aimed at generating (growing) new alveoli.



As for the progressive nature of the disease, most literature I've been able to locate makes statements like this -
"Those patients who smoke should stop smoking immediately; this is the most important step patients can take to stabilize their disease and guard against further lung damage." 

Creighton University Medical Center



"The emphysematous patient must stop smoking to retard progression of the disease."

Canadian Lung Association

This is the portion of the above post you highlighted ..."but the tissue in the lungs that is a sleep, (meaning coated) will wake up when the damaging source is stopped being put into the lungs...."



Anastazia, I have yet to read anything contrary to above statement and much of Joel's wonderful post about the beauty of cilia healing I'm sure applies to all still living cells coated knee-deep beneath any chemical build-up.



What I would like to think is that because I stopped pumping the 4,000+ chemicals delivered into my lungs with each puff, that my emphysema will never ever grow any worse than it is right now, so long as I never take another puff. I wish it was true. Clearly I've brought an abrupt halt to smoking's intentional destruction of my remaining capacities but those remaining capacities are still subject to both the normal aging process, other environmental agents aside from cigarette smoke, and any genetic susceptibilities to emphysema that my deceased mother (advanced emphysema), my sister (moderate) and I (light) have already demonstrated exist in our family.



Will quitting smoking help substantially increase overall lung function for every person with emphysema? I'd love to hear an emphysema expert's answer to that question as it would seem to me that to one degree or another the elasticity and performance of every still living alveolus must be enhanced by not having to fight the 3,500+ particles and 500+ gases arriving with each puff. I can't speak for everyone but I can for my sister and I and in our cases we've noticed tremendous improvement in both breathing capacities and endurance.

John
Last edited by John (Gold) on July 22nd, 2010, 8:49 pm, edited 3 times in total.
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John (Gold)
John (Gold)

November 27th, 2002, 11:04 pm #25

Yesterday I emailed a friend at the American Lung Assocation posing the following two questions. The response I just received follows:
How much does quitting smoking halt the progression of the disease?

Does every person with emphysema experience an overall increase in their remaining lung function capacities when quitting?
John - this was from the pathologist. One thing to add into the mix is the
degeneration due to ageing.

****
> In most cases, the progression of the disease stops when the smoking
> stops. In the rest of the cases, it usually slows down. However, there
> is no repair of the lung that has dissolved.
> Large and small airways diseases are also caused by smoking and
> contribute to the symptoms. Much of this is reversible. Cough and
> phlegm usually intensify for a few days to a few weeks, then get better
> and go away. Along with this, the larger airways open up some and
> airflow gets better. There's a lot of variation from person to
> person.
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OBob Gold
OBob Gold

February 2nd, 2003, 5:32 am #26

Added the following after noticing the use of bronchodilators for the treatment of emphysema above. My question, would it be reasonable to expect that symptoms of emphysema could be masked by the bronchodilators in cigarette smoke?... would it also, then, be reasonable to conclude that the symptoms of emphysema could seem worse after quitting, due to the lack of those bronchodilators?

Not looking for medical advice, of course, but I think it's a worthy discussion issue given the potential for someone to blame their quit for a worsening of their pulmonary function.




From: GrumpyOMrsS (Gold) Sent: 3/2/2002 6:10 AM

Just a note to John concerning the additives in your Vantage cigarettes and all other brands as well.....the first two you mentioned, licorice and cocoa are the vehicles put in the cigarettes not only to enhance the taste and smell, but they are actually the bronchodialors in cigarettes. those are the two ingredients added to cigarettes to make sure that our bronchii are open and able to accept the nicotine for faster delivery to the brain. Cocoa contains theopholine, the chemical used in inhalers for asmatatics and others suffering from COPD, as well as the licorice which contains, Glycyrrhizin. This explains in part why many people reach for chocolate or black licorice after quitting smoking. By the way, besides many calories for both chocolate and licorice, the glycyrrhizin in licorice, if ingested in larger than normal quatities, has the ability to raise one's blood pressure according to my pulmonologist. So this must be watched too.


below the findings in the tobacco hearings:



3.4.3 Cocoa and theobromine

Widely used as an additive, cocoa contains alkaloids, which may modify the effects of nicotine and have a pharmacological effect in themselves. Cocoa also contains about 1% theobromine, a 'bronchodilator' - encouraging expansion of the airways and facilitating increased smoke and nicotine intake.

The following quotes are from scientific and medical papers held by Philip Morris:



"Theobromine: The principal alkaloid of the cocoa bean which contains 1.5-3% of the base... bronchodilation effect in asthma."51

"The bronchodilator effect of a 10mg dose of theobromine was compared with that of 5mg of theophylline in young patients with asthma.... In this single dose study the bronchodilatory effect produced by theobromine was clinically and statistically significant.... improvement in all pulmonary function tests was noted after the ingestion of theobromine or theophylline."52 The addiction of these chemicals, in many cases, may mask an underlying problem when smoking. Stop smoking and take away these additives and a person who does not know he has asthma or emphsema or other symptoms of COPD is at once faced with a difficulty breathing from lack of broncodiators. This is how I found out I had asthma. Of course keep on smoking and you're liable to end up with much, much worse.



3.4.4 Glycyrrhizin

An ingredient of liquorice - another commonly used additive, glycyrrhizin also acts as a bronchodilator.

"What does a bronchodilator do? The bronchodilator makes it easier for you to inhale, so obviously if you are having difficulty putting smoke in your lungs, it's good to have a bronchodilator in there. Now I was asked recently whether I knew whether the glycerizon being delivered is delivered in adequate concentration to cause that to happen. I do not know the answer to that question. It would be interesting to know whether that has been studied by the industry. If they have studied it, it would seem that that is the kind of information that should be shared with regard to ingredients. The point is, however, that we know it can happen, it is a bronchodilator. The probability that it happens is very high, but that would be related to studies that should be done."53 (Farone WA 1997)

Linda

2 years free
Last edited by OBob Gold on July 22nd, 2010, 8:52 pm, edited 1 time in total.
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MareBear GOLD
MareBear GOLD

March 7th, 2003, 10:52 pm #27

Thanks for bringing up this thread, Joanne. I had never read it because I didn't think it applied to my life. Unfortunately I think we are all affected one way or another by smoking-related conditions.

There is a very dear, sweet lady whose office is next door to mine, and she was a heavy smoker for over 30 years. She has emphysema, asthma and chronic bronchitis, yet she continued to smoke until about a month before I quit. She quietly quit (didn't tell a soul until people started noticing) with a nicotine patch and was still on it for about a month after I had quit. Once she withdrew from the patch she was OK and seemed to understand the concept of the Law of Addiction. I guess I just assumed she was listening to me talk about Freedom, since we had something in common. It was wonderful not to hear that constant racking, phlegm-y cough and I often asked her how she was feeling since she'd quit, and she'd answer that she hadn't felt this good in years.

However, over the last few weeks I've caught her smoking twice (she doesn't know this). I printed out a few articles and left them around where she'd see them, and found them in the trash. Now, that horrible cough is back, and she's back to calling in sick once or twice a week. Sometimes she's just too weak to get in her car and drive to work. It breaks my heart that she's relapsed, that she's killing herself again. As I type this I can hear her struggling to breathe. I don't guess there's much else I can do, but it sure felt good to get this off my chest. Thanks for listening.

YQS,
MareBear

9 months, 1 week, 1 day
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sondrat123
sondrat123

February 4th, 2006, 9:44 am #28

My dad suffered from this disease for 20 years before he was diagnosed with lung cancer and 14 months later died from that. I am not afraid of picking up a nicotine delivery device again and DYING.....I'm afraid that I'd pick it up and live the way he did for 20 years. His whole life was compromised by the disease. And still he smoked until 4 days before he died. If that isn't addiction, I don't know what is! And sadly, I smoked with him and continued for 10 years after he died.

I am now quit for 28 days (and the rest of my life, one day at a time) and my sister is quit for 8 days. I think my dad has interferred with our lifes and, somehow, gave us the insight to be able to break this chain. I am 58, my sister 50 and it's taken us this long to get the message!! But got it we did and we are on our way to living happy, joyous and free of any substance. All we have to do is NTAP!!!

sandy -a nicotine addict who hasn't used nicotine for Twenty Eight Days, 23 Hours and 15 Minutes, while extending my life expectancy 1 Day and 12 Hours, by avoiding the use of 435 nicotine delivery devices that would have cost me $65.26.
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FoolishWorkinj
FoolishWorkinj

February 4th, 2006, 12:27 pm #29

Such scary stuff. I need to read it, to remember it, to reject the drug that causes it. Thanks to Freedom
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FoolishWorkinj
FoolishWorkinj

April 17th, 2006, 11:58 pm #30

I have a brilliant friend -- a writer, actor, and teacher -- who is maybe 62 years old, and I find myself avoiding her because it is soo painful to be in her house, where it's so hard to breathe through all the cigarette smoke, and then, through a cloud of smoke, watch her labored breathing. A couple of years ago, I took a walk with her and was stunned with fear and sadness at how much lung capacity she was losing to emphysema. Thank you for bringing this thread back, Sal.
I thank my lungs every day for supporting my life, and now, I can only hope that all of us have quit in time.

best, joanne, free for 97 days
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KatieDidIt1999
KatieDidIt1999

July 21st, 2006, 9:28 am #31

My dad smoked filterless cigs or roll your own for nearly 60 years. After hauling him and his oxygen tank around to doctor appointments today....this one seemed like a good one to bring up.
Kat
6 months +
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JoeJFree Gold
JoeJFree Gold

August 22nd, 2006, 9:01 am #32

A point of clarification: I read today in a journal that COPD is an easier way of saying Emphysema.

Emphysema is but one of the forms of COPD. There are several different and very distinct diseases (contracted usually by extended direct use exposure to tobacco smoke) that are grouped under the term COPD. It is important that what we all post here be factually correct.

JoeJ Free - GoldClub
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beth19724
beth19724

August 22nd, 2006, 10:48 am #33

Great information!

Never Take Another Puff!
Elizabeth - Free and Healing for Thirteen Days, 11 Hours and 18 Minutes, while extending my life expectancy 1 Day and 4 Hours, by avoiding the use of 337 nicotine delivery devices that would have cost me $101.09.
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TJKee
TJKee

September 15th, 2006, 7:45 am #34

Boy did I need to read this ...
Hit with a crave as I sat down to eat dinner after a long, hard day.
How 'bout inhaling a mouthful of emphysema?
My junkie had no reply ...

Thanks for this.
Thanks very much.
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John (Gold)
John (Gold)

September 23rd, 2006, 8:21 am #35

Much lung disease 'undiagnosed'
BBC News - Sept. 20, 2006

Four out of five adults with long-term lung disease do not know they are ill, research suggests.
The condition, Chronic Obstructive Pulmonary Disease (COPD), includes chronic bronchitis and emphysema.

It is strongly associated with lung cancer because both arise from long-term damage to lung tissue, which can be caused by smoking.

The study of 8,215 adults by the charity Cancer Research UK is published online by the journal Thorax.

Researchers studied the results of saliva and lung function tests.
COPD
  • It is estimated that 13.3% of Britons over 35 may have developed features
  • Between 600,000 and 900,000 people in the UK have been diagnosed with COPD
  • COPD is the sixth most common cause of death in England and Wales killing more than 30,000 a year
They identified 1,093 people with COPD based on impaired lung function, but more than 80% said they had not received diagnosis of any kind.

Even among those with severe COPD more than half had not been diagnosed.

More than one third of those with the condition were still smoking and a further 35% were ex-smokers.

Sufferers were more likely to be older, manual workers, male and more socio-economically deprived.

Little motivation

The study also found that smokers who had COPD showed higher levels of dependence on cigarettes and smoked more cigarettes a day than smokers without the disease.

But those with COPD were no more motivated to quit than smokers without the disease.

Lead researcher Professor Robert West, director of tobacco studies at Cancer Research UK's Health Behavioural Unit, said: "It is crucial to identify smokers with COPD and take urgent action to support them in stopping smoking because the most effective way of halting the progression of the disease is to stop smoking.

"Many smokers feel that they will 'get away with it' and not be affected in a serious way by their habit.

"For smokers with COPD that doubt is removed. Every day they continue to smoke will make things worse."

Professor West said many smokers thought the symptoms of COPD - such as a smokers' cough or becoming breathless during exercise - were normal.

"They do not realise that they can be the beginnings of a disease which, in many cases, will leave them disabled or dead if they do not stop smoking.

"It only requires a simple lung function test to find out whether they have COPD and this can be done by their GP."

Dr Lesley Walker, director of cancer information at Cancer Research UK, said: "Smokers run the biggest risk of COPD but we also know it can affect people who have never smoked as well as those who have given up smoking.

"There is a real need to increase public awareness of this insidious disease."

Dame Helena Shovelton, chief executive of the British Lung Foundation, welcomed the research, and said the charity would be launching a campaign in October to raise awareness of COPD.



Published: 2006/09/20 23:07:14 GMT

© BBC MMVI
Thanks for this find, Sallie!
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Joined: January 16th, 2003, 8:00 am

February 23rd, 2007, 12:57 am #36

From Message #25 by Joel:
The underlying lung tissue which is destroyed cannot regenerate. In a sense then, the loss of lung elasticity cannot come back. But the lining tissue of the wind pipe does regenerate. This tissue, primarily the Cilia is key to sweeping out the lungs, keeping the airways open and making breathing easier. So by this tissue being repaired, even though you don't get back the lungs elasticity, it keeps the airways cleaner and makes it easier for the remaining lung tissue to work without small airway obstructions. Added to this is the bonus of the blood's ability to carry much larger amounts of oxygen than when poisoned by carbon monoxide from tobacco smoke. Again, the lungs as well as the heart's workload is decreased when the blood carries the extra oxygen.

See articles:
Smoking's Impact on the Lungs
Smoking and Circulation
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John (Gold)
John (Gold)

November 30th, 2007, 10:04 pm #37

Smoking Boom Catches Up With Women

By DENISE GRADY
Posted: 2007-11-29 11:59:47

(Nov. 29) -- For Jean Rommes, the crisis came five years ago, on a Monday morning when she had planned to go to work but wound up in the hospital, barely able to breathe. She was 59, the president of a small company in Iowa. Although she had quit smoking a decade earlier, 30 years of cigarettes had taken their toll.
After several days in the hospital, she was sent home tethered to an oxygen tank, with a raft of medicines and a warning: "If I didn't do something, life was going to continue to be a pretty scary experience."

Ms. Rommes has chronic obstructive pulmonary disease, or C.O.P.D., a progressive illness that permanently damages the lungs and is usually caused by smoking. Once thought of as an old man's disease, this disorder has become a major killer in women as well, the consequence of a smoking boom in the 1950s, '60s and '70s. The death rate in women nearly tripled from 1980 to 2000, and since 2000, more women than men have died or been hospitalized every year because of the disease.

"Women started smoking in what I call the Virginia Slims era, when they started sponsoring sporting events," said Dr. Barry J. Make, a lung specialist at National Jewish Medical and Research Center in Denver. "It's now just catching up to them."

Chronic obstructive pulmonary disease actually comprises two illnesses: one, emphysema, destroys air sacs deep in the lungs; the other, chronic bronchitis, causes inflammation, congestion and scarring in the airways. The disease kills 120,000 Americans a year, is the fourth leading cause of death and is expected to be third by 2020. About 12 million Americans are known to have it, including many who have long since quit smoking, and studies suggest that 12 million more cases have not been diagnosed. Half the patients are under 65. The disease has left some 900,000 working-age people too sick to work and costs $42 billion a year in medical bills and lost productivity.

"It's the largest uncontrolled epidemic of disease in the United States today," said Dr. James Crapo, a professor at the National Jewish Medical and Research Center.

Experts consider the statistics a national disgrace. They say chronic lung disease is misdiagnosed, neglected, improperly treated and stigmatized as self-induced, with patients made to feel they barely deserve help, because they smoked. The disease is mired in a bog of misconception and prejudice, doctors say. It is commonly mistaken for asthma, especially in women, and treated with the wrong drugs.

Although incurable, it is treatable, but many patients, and some doctors, mistakenly think little can be done for it. As a result, patients miss out on therapies that could help them feel better and possibly live longer. The therapies vary, but may include drugs, exercise programs, oxygen and lung surgery.

Incorrectly treated, many fall needlessly into a cycle of worsening illness and disability, and wind up in the emergency room over and over again with pneumonia and other exacerbations - breathing crises like the one that put Ms. Rommes in the hospital - that might have been averted.

"Patients often come to me with years of being under treated," said Dr. Byron Thomashow, the director of the Center for Chest Disease at NewYork-Presbyterian/Columbia hospital.

Still others are overtreated for years with steroids like prednisone, which is meant for short-term use and if used too much can thin the bones, weaken muscles and raise the risk of cataracts.

Adequate treatment means drugs, usually inhaled, that open the airways and quell inflammation - preventive medicines that must be used daily, not just in emergencies. It is essential to quit smoking.

Patients also need antibiotics to fight lung infections, vaccines to prevent flu and pneumonia and lessons on special breathing techniques that can help them make the most of their diminished lungs. Some need oxygen, which can help them be more active and prolong life in severe cases. Many need dietary advice: obesity can worsen symptoms, but some with advanced disease lose so much weight that their muscles begin to waste. Some people with emphysema benefit from surgery to remove diseased parts of their lungs.

Above all, patients need exercise, because shortness of breath drives many to become inactive, and they become increasingly weak, homebound, disabled and depressed. Many could benefit from therapy programs called pulmonary rehabilitation, which combine exercise with education about the disease, drugs and nutrition, but the programs are not available in all parts of the country, and insurance coverage for them varies.

"I have a complicated, severe group of patients, but I will swear to you that very few wind up in hospitals," Dr. Thomashow said. "I treat aggressively. I use the medicines, I exercise all of them. You can make a difference here. This is an example of how we're undertreating this entire disease."

Little-Known Epidemic

Researchers say there is so little public awareness of how common and serious C.O.P.D. is that the O might as well stand for "obscure" or "overlooked."

The disease may not be well known, but people who have it are a familiar sight. They are the ones who cannot climb half a flight of stairs without getting winded, who have a perpetual smoker's cough or wheeze, who need oxygen to walk down the block or push a cart through the supermarket. Some grow too weak and short of breath to leave the house. The flu or even a cold can put them in the hospital. In advanced stages, the lung disease can lead to heart failure.

"This is a disease where people eventually fade away because they can no longer cope with life," said Grace Anne Dorney Koppel, who has chronic lung disease. (Ms. Dorney Koppel, a lawyer, is married to Ted Koppel.) "My God, if you don't have breath, you don't have anything."

Most cases, about 85 percent, are caused by smoking, and symptoms usually start after age 40, in people who have smoked a pack a day for 10 years or more. In the United States, 45 million people smoke, 21 percent of adults. Only about 20 percent of smokers develop chronic lung disease.

The illness is not the same as asthma, but some patients have asthma along with their other lung problems. Most have a combination of emphysema and chronic bronchitis. In about one-sixth of cases, emphysema is the main problem. Women are far more likely than men to develop chronic bronchitis, and are less prone to emphysema. Some studies have suggested that women's lungs are more sensitive than men's to the toxins in smoke.

Worldwide, these lung diseases kill 2.5 million people a year. An article in September in The Lancet, a medical journal, said that "if every smoker in the world were to stop smoking today, the rates of C.O.P.D. would probably continue to increase for the next 20 years." The reason is that although quitting slows the disease, it can develop later.

Cigarettes are the major cause worldwide, but other sources are important in developing countries, especially smoke from indoor fires that burn wood, coal, straw or dung for heating and cooking. Women and children are most likely to be exposed. Outdoor air pollution plays less of a part: it can aggravate existing disease, but is believed to cause only 1 percent of cases in rich countries and 2 percent in poorer ones. Occupational exposures in cotton mills and mines may contribute.

Researchers have differed about whether passive smoking plays a role, but a Lancet article in September predicted that in China, among the 240 million people who are now over 50, 1.9 million who never smoked will die from chronic lung disease - just from exposure to other people's smoke.

Many patients with lung disease have other illnesses as well, like heart disease, acid reflux, hypertension, high cholesterol, sinus problems or diabetes. Compared with other smokers, those with C.O.P.D. are more likely to develop lung cancer as well. Researchers suspect that all the ailments stem partly from the same underlying condition, widespread inflammation, a reaction by the immune system that can affect blood vessels, organs and tissues all over the body.

Lung disease can creep up insidiously, because human beings have lung power to spare. Millions of airways, with enough surface area to cover a tennis court, provide so much reserve that most people would not notice it if they lost the use of a third or even half of a lung. But all that extra capacity can hide an impending disaster.

"If it comes on gradually, the body can adjust," said Dr. Neil Schachter, a lung specialist and professor at Mount Sinai Medical Center in New York. "Some of these patients are at oxygen levels where you and I would be gasping for breath."

People adjust psychologically as well, cutting back their activities, deciding perhaps that they just do not enjoy sports anymore, that they are getting older, gaining weight or a bit out of shape. But at some point the body can no longer compensate, and denial does not work anymore.

"It's like trying to breathe through a straw," Dr. Schachter said. "It's very uncomfortable."

By then, half a lung might be ruined. On a CT scan, he said, the lungs may look "moth-eaten," full of holes where tissue has been destroyed.

Often, the diagnosis is not made until the disease is advanced. Even though breathing tests are easy to perform and recommended for high-risk patients like former and current smokers, many doctors do not bother. People who do get a diagnosis frequently are not taught how to use the inhalers that are the mainstay of treatment. Access to pulmonary rehabilitation is limited because Medicare has left coverage decisions to the states. Some programs have shut down, and there are bills in the House and Senate that would require pulmonary rehabilitation to be covered by Medicare. Medicare may also reduce coverage for home oxygen.

Meanwhile, billions are spent on treating exacerbations, episodes of severe breathing trouble that are often caused by colds, flu or other respiratory infections.

A recent study of 1,600 consecutive hospitalizations for chronic lung disease in five New York hospitals found that once patients were in the hospital, their treatment was generally correct, Dr. Thomashow said. But "most upsetting," he said, was that the majority had been incorrectly treated before going to the hospital.

For many, trying to control the disease, rather than be controlled by it, is a daily struggle. Diane Williams Hymons, 57, a social service consultant and therapist in Silver Spring, Md., has had lifelong problems with bronchitis, allergies and asthma. In the last five or 10 years, her breathing difficulties have worsened, but she was told only three years ago that she had C.O.P.D. It motivated her to give up cigarettes, after smoking for more than 30 years.

"I have good days, and days that aren't as great," she said. "I sometimes have trouble walking up steps. I have to stop and catch my breath."

She is "usually fine" when sitting, she said.

Her mother, also a former smoker with chronic lung disease, has been in a pulmonary rehabilitation program. Ms. Williams Hymons's doctor has not recommended such a program for her, but she has no idea why. They have discussed surgery to remove part of her lungs, which helps some people with emphysema, but she said no decision had been made yet because it is not clear whether her main problem is emphysema or asthma. She is not sure what her prognosis is.

A Risky Approach

Ms. Williams Hymons has been taking prednisone pills for years, something both she and her doctor know is risky. But when she tries to cut back, the disease flares up. She has many side effects from the drug.

"My bone density is not looking real good," she said. "I have cramps in my hands and feet, weight gain and bloating, the moon face, excess facial hair, fat deposits between my shoulder blades. Yes, I have those."

She has broken two ribs just from coughing, probably because the prednisone has thinned her bones, she said. She went to a hospital for the rib pain last year and was given so much asthma medication to stop the coughing that it caused abnormal heart rhythms. She wound up in the cardiac unit for five days, and now says "never again" to being hospitalized.

Her doctor orders regular bone density tests.

"I know he's concerned, like I'm concerned," Ms. Williams Hymons said, "but we can't seem to kind of get things under control."

A recent study of 25 primary care practices around the United States treating chronic lung disease found that most did not perform spirometry, a simple breathing test used to diagnose or monitor the disease, even when they had the equipment to do so. The test takes only a few minutes, but doctors said there was not enough time during the usual 15-minute visit. Similarly, the practices did not offer much help with smoking cessation.

The author of the study (published in August in The American Journal of Medicine), Pamela L. Moore, said many of the doctors felt unable to help smokers quit, and believed that as long as patients kept smoking, treatments for lung disease would be for nought. But Dr. Moore said research had found that people are more likely to quit or start cutting back if doctors recommend it.

Labeling the disease self-induced is "an unbelievably painful concept," Dr. Thomashow said. "Patients blame themselves, their family blames them, we even have evidence that health providers blame them."

Shame and Blame

Indeed, a patient at a clinic in Manhattan, with nasal oxygen tubing attached to equipment in a backpack, said, "This is one of the evils you must suffer for the things we did in our life."

Smoking also contributes to heart disease, Dr. Thomashow said, and yet people "don't waste time blaming the patient."

"This disease quite frankly has an image problem," said Dr. James Kiley, the director of lung research at the National Heart, Lung and Blood Institute, which started a campaign last January to educate people about the disease.

In one way or another every patient seems to have encountered what John Walsh, president of the C.O.P.D. Foundation, calls the "shame and blame" attached to this disease.

It is a familiar theme to Ms. Dorney Koppel, who agreed to become a spokeswoman for the institute's education campaign. She was surprised to be asked to help, she said, because the campaign needed a celebrity, and she is merely married to one. She asked the person who invited her, whether there were no famous people with C.O.P.D.

"I was told, 'None who will admit it,'" she said.

Ms. Dorney Koppel, who is candid about being a former smoker, calls the illness the Rodney Dangerfield of diseases.

"You don't get no respect," she said. "I have to pay publicly for my sins. I have paid."

Like many patients, Ms. Rommes has both emphysema and chronic bronchitis, along with asthma. She had symptoms for years before receiving the correct diagnosis.

She began smoking in college during the 1960s, when she was 18. People whom she admired smoked, and it seemed cool. She smoked for 30 years.

When she quit in 1992, it was not because she thought she was ill, but because she realized that she was organizing her day around chances to smoke. But she almost certainly was ill. She was only 50, but climbing a flight of stairs left her winded. From what she found in medical dictionaries, she began to suspect she had lung disease.

By 2000 she was so short of breath that she consulted her doctor about it.

He gave her a spirometry test. In one second, healthy adults should be able to blow out 80 percent of the total they can exhale; her score was 34 percent, which, she knows now, indicated moderate to severe lung disease.

"I honestly don't know whether he knew," she said of her doctor. "I suspect he did, but he didn't call it emphysema."

"He put me on a couple of inhalers and he called it asthma," Ms. Rommes said. "I sort of ignored the whole thing, because the inhalers did make me feel better. I started to gain some weight, and things got progressively worse."

She cannot help wondering now if she could have avoided becoming so desperately ill, if she had only known sooner what a dangerous illness she had.

The turning point came in February 2003 when she tried to take a shower and found that she could not breathe. The steam all but suffocated her. She managed to drive from her home in Osceola, Iowa, to her doctor's office, struggle across the parking lot like someone climbing a mountain and collapse, gasping, onto a couch inside the clinic. Her blood oxygen was perilously low, two-thirds of normal, even when she was given oxygen. The hospital was next door, and her doctor had her admitted immediately.

Fear and Anger

She had Type 2 diabetes as well as lung disease, and her doctor told her that losing weight would help both illnesses. But she said, "He made it pretty clear that he didn't think I would or could."

Motivated by fear and anger, she began riding an exercise bike, walking on a treadmill, lifting weights at a gym and eating only 1,200 to 1,500 calories a day, mostly lean meat with plenty of vegetables and fruit.

"I kind of came to the conclusion that if I didn't, I probably wasn't going to be around," Ms. Rommes said. "I wasn't ready to check out. And my husband was beginning to show the signs of Alzheimer's disease. I knew that if I couldn't continue to manage our affairs, it wasn't going to work out."

By December 2003, her efforts were starting to pay off. She went from needing oxygen around the clock to using it only for sleeping, and by January 2005 she no longer needed it at all. She was able to lower the doses of her inhalers and diabetes medicines. By February 2005, she had lost 100 pounds.

The daily exercise also helped her deal with the stress of her husband's illness. He died in June.

"I had no clue that exercise would do as much for ability to breathe as it did," she said, adding that it helped more than the drugs, which she described as "really pretty minimal."

She is hooked on exercise now, getting up every morning at 5 a.m. to walk for 45 minutes on the treadmill. She goes at it hard enough to break a sweat, wearing a blood oxygen monitor to make sure her level does not dip too low (if it does, she slows down or uses special breathing techniques to bring it up). She walks outdoors, as well, and three times a week, she works out with weights at a gym.

"Exercise is absolutely essential, and it's essential to start it as soon as you know you have C.O.P.D.," she said.

Exercise does not heal or strengthen the lungs themselves, but it improves overall fitness, which people with lung disease need desperately because their shortness of breath leads to inactivity, muscle wasting and loss of stamina.

"Both my pulmonologist and my regular doctor have made it really, really clear to me that I have not increased my lung capacity at all," Ms. Rommes said. "But I've improved the mechanics. I've done everything I know how to do to make the lung capacity as efficient as possible. That's the key for me; I know there are lots of people with this disease who don't exercise, who I guess just give up."

She realizes that she has two serious chronic diseases that could shorten her life. But it does not worry her much, she said, because she figures she is doing everything she can to take care of herself, and would rather spend her time enjoying life - work, reading, opera, traveling, children and grandchildren.

"I will tell pretty much anybody that I have emphysema," Ms. Rommes said. "They say, 'Did you smoke?' I say, 'Yes I did, for 30 years, and I quit in 1992.' Maybe it's why I've attacked this the way I did. O.K., I did it to myself, and so I better do everything I can to get out of it. We all do things in our lives that are stupid, and then you do what you can to fix it."

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Last edited by John (Gold) on April 6th, 2009, 9:35 am, edited 2 times in total.
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Joined: January 16th, 2003, 8:00 am

January 26th, 2008, 9:08 am #38

Emphysema - feel how smoking affects your lungs:
Okay everyone, take a deep breath and hold it. Without letting out any air, take another deep breath. Hold that one too. One more time, take one more breath. Okay let it all out.

That second or third breath is what it feels like to breath when you have advanced emphysema. Emphysema is a disease where you cannot exhale air. Everyone thinks that it is a disease where you cannot inhale but in fact it is the opposite. When you smoke you destroy the lungs elasticity by destroying the tissue that pulls your lung back together after using muscles that allow us to inhale air. So when it comes time to take your next breath it is that much more difficult, for your lungs could not get back to their original shape.

Imagine going through life having to struggle to breath like those last two breaths I had you take. Unfortunately, millions of people don't have to imagine it, they live it daily. It is a miserable way to live and a slow painful way to die.

So when you take your normal breaths recognize that you are not in pain or on oxygen. You are hopefully breathing normally. This is a gift you have given yourself by quitting, the ability to breath longer. Never lose sight of this fact. To keep your ability to breath better for the rest of your life always remember to never take another puff!

Joel
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FreedomNicotine
FreedomNicotine

April 6th, 2009, 9:26 am #39


I don't know where to post this. When I was young, I thought smoking looked cool and I wanted to keep my
weight down. Well, I am still puffing, but it's on a nebulizer. That doesn't look too cool. I thought I had asthma like my grandmother. When I was hospitalized due to pneumonia, I found out I had very severe emphysema. Part of my lung was closed off due to infection. I was gasping for every breath, shaking from head to foot. When it was over and I was finally released, I was even on heart medication. A month later, I relapsed. About that same time I found out that on a good day I have 30% lung capacity! That is a
little more than one half of one lung. The second time, I even had pleurisy and had to spend days in intensive care on morphine. After 18 hours in the emergency room!

After the two rounds of pneumonia, my breathing was worse than before, perhaps some scaring. I wake up every day feeling like I just ran a race and want to grab my knees to catch up on oxygen. I never will catch up. Smoking doesn't just shorten your life, it ruins whatever is left as well. This is a slow death, I tire so easily can't finish half of what I start.

I nearly died twice already. The second time in the hospital, my heart rate was 158 if I even rolled over. My blood pressure dropped to 47 over 23. Monitors were going off all the time.

I still remember all the ads from the 50s. Actors posing as doctors saying some brand was "Just what the doctor ordered." Bette David in the old movies always had a cigarette in her hand. She went from being a beautiful woman to a hag with a cigarette still in her hand. Smoking does not help you age
well either. I look 7 or 8 years older than I did just 2 years ago.

There is nothing cool about Kools or any other brand of that poison. If someone invented cigarettes today, the FDA would not approve them. They should have banned them long ago. I guess the profits and the taxes are addicting too.

G. Whitney
Dalls, Texas
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yoshi
yoshi

April 7th, 2009, 6:54 am #40

Thank you for sharing this. It means a lot to me as a ex-smoker as I am sure it means so much to the rest of this community.
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FreedomNicotine
FreedomNicotine

October 19th, 2009, 8:46 pm #41

The below just released paper suggests that bronchodilators
in the hands of smokers may be a horrible mistake. They're
undertaking a study to test their hypothesis.



Interaction in COPD experiment (ICE):
A hazardous combination of cigarette
smoking and bronchodilation in
chronic obstructive pulmonary disease

Med Hypotheses. 2009 Sep 30. [Epub ahead of print]

van Dijk WD, Heijdra Y, Scheepers PT, Lenders JW, van Weel C, Schermer TR.

Abstract

Chronic obstructive pulmonary disease (COPD) is a highly prevalent disease, characterised by poorly reversible, obstructive airflow limitation. Alongside other comorbidities, COPD is associated with increased morbidity and mortality resulting from cardiovascular disease - mainly heart failure and ischemic heart disease. Both diseases share an important risk factor, namely, smoking. About 50% of COPD patients are active cigarette smokers.

Bronchodilation is the cornerstone of pharmaceutical treatment for COPD symptoms, and half of all COPD patients use long-acting bronchodilating agents. Discussion about these agents is currently focusing on the association with overall mortality and morbidity in COPD patients, of cardiovascular origin in particular.

Bronchodilation diminishes the hyperinflated state of the lung and facilitates the pulmonary deposition of cigarette smoke by deeper inhalation into the smaller airways. Smaller particles, as in smoke, tend to penetrate and depose more in these small airways. In addition, bronchodilation indeed increases carbon monoxide uptake in the lungs, an important gaseous compound of cigarette smoke. Since the number of cigarettes smoked is positively correlated to mortality from cardiac events, we therefore hypothesise that chronic bronchodilation increases cardiovascular disease and mortality in COPD patients who continue smoking by increasing pulmonary retention of pathogenic smoke constituents.

Indeed, a recent meta-analysis is suggestive that long-acting anticholinergics might increase cardiovascular disease if patients exceed a certain number of cigarettes smoked. To demonstrate the fundamental mechanism of this pathogenic interaction we will perform a randomised placebo-controlled cross-over trial to investigate the effect of maximum bronchodilation on the retention of cigarette smoke constituents. In 40 moderate to severe COPD patients we measure the inhaled and exhaled amount of tar and nicotine, as well during maximum bronchodilation as during administration of placebo. The fraction of retention of tar and nicotine is subsequently calculated for both circumstances and analysed for association with bronchodilation. Further observational cohort studies or randomised clinical trials designed to monitor cardiovascular events may well evaluate the interaction.

Since many patients are at risk for this possibly hazardous interaction, its relevance to our society and healthcare is potentially great. The implication will be that the urgency to quit smoking is intensified. Besides, chronic bronchodilation - specifically long-acting bronchodilators - needs to be discouraged in smoking COPD patients that refuse to quit.



http://www.sciencedirect.com/science/journal/03069877
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