Ask the Doctor: Chronic Lung Disease

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Author: 
Franklin McCoy, M.D., <i>The E

Question: I have recently read that chronic lung disease is much more common in women than most people realize. What can I do to avoid this problem?

Answer: Don't smoke.

Chronic Obstructive Pulmonary Disease (COPD) is the most common form of chronic lung disease. The two principle categories of COPD are emphysema and chronic bronchitis, although the diseases overlap.

Emphysema is a disease characterized by the loss of small air sacs and the formation of larger ones, which results in a reduction of the surface area for oxygen and carbon dioxide exchange. This results in lung enlargement, causing less movement of the diaphragm, making breathing difficult.

Chronic bronchitis is characterized by inflammation and thickening of the breathing tubes and an increased number of mucus-producing cells in the lungs. This increase in mucus production impairs the normal airflow and predisposes to infection.

COPD is the fourth leading cause of death in the U.S. and the world.

From 1980 to 2000, the death rate in the U.S. due to COPD in women increased from 20.1 per 100,000 to 56.7 per 100,000, while that in men increased from 73.0 per 100,000 to 82.6 per 100,000.

Hospitalizations and emergency room visits for COPD have become greater for women than for men. In 2000, more women than men died of COPD.

What is happening? Has this illness suddenly struck women without warning? Why the much greater increase in women than in men?

"These increases probably reflect the increase in smoking by women, relative to men, since the 1940s. In the United States, a history of currently or formerly smoking is the risk factor most often linked to COPD, and the increase in the number of women smoking over the past half-century is mirrored in the increase in COPD rates among women," according to the National Center for Environmental Health, a branch of the Centers for Disease Control (CDC) (http://www.cdc.gov/nceh/airpollution/copd/copdfaq.htm).

"Most people with COPD are smokers or former smokers." (From National Heart, Lung and Blood Institute)

The degree of severity of emphysema and chronic bronchitis is diagnosed with a non-invasive breathing test called spirometry.

The diagnostic stages of COPD are: At risk, mild, moderate and severe, with the former being a person who has a mild chronic cough, but no other symptoms and the latter being barely able to function due to difficulty breathing.

COPD tends to worsen with time, and there is no known medical cure. Ordinary medical treatment is directed toward the elimination of infections by the use of antibiotics, medications to dilate the bronchial tubes, medication to reduce inflammation, oxygen treatments, and so on.

More information on COPD from the National Heart, Lung and Blood Institute can be found at http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_WhatIs.html

While I was a U.S. Army physician, I had the opportunity work in a dispensary, which treated a large number of troops. After gaining a lot of experience examining many patients, I listened to their lungs and estimated the amount they smoked. After a while, I became rather accurate in the estimation. One day, after listening to someone's chest, I pronounced that he didn't smoke. "I smoke a pack a day," was the response. I was shocked! His lungs were as clear as a bell. It turned out that he was taking a gram (1,000 mg) of vitamin C every day. Subsequently, I have read recommendations that if one is smoking, one should increase his or her vitamin C intake.