Health: The Other Lung Disease

It used to take Bernard Regeth, 76, just 15 minutes to harness his two horses. "Now," says the retired mechanic from River Falls, Wis., "it takes a good hour. I put the collar on, and I have to sit down and rest. I put the harness on, and I have to sit down and rest. I buckle the harness, and I have to sit down and rest." If he exerts himself too much at a routine task like sweeping the kitchen floor, he feels as if he's suffocating. "I have to completely sit down and take a puff off of one of my puffers until it goes away."

Regeth suffers from a disease most people never think about. Most haven't even heard of it, at least by the official name used by doctors, researchers and advocacy groups like the American Lung Association. A person might worry about getting heart disease or cancer or Alzheimer's, but who sits around fretting about chronic obstructive pulmonary disease (COPD)?

Lung cancer is deadlier (it killed 150,000 Americans in 2000, vs. 120,000 for COPD), but COPD is more common--by a long shot. Some 13 million Americans suffer from COPD, nearly 40 times as many as have lung cancer. In fact, this "other" lung disease--a condition that includes more familiar illnesses such as chronic bronchitis and emphysema--is the fourth leading cause of death in the U.S., after cardiovascular disease, certain cancers and stroke. The number of deaths due to COPD has nearly doubled over the past two decades, and the most dramatic increase has occurred in women. In 2000, for the first time, COPD killed more females than males. By 2020, it may be the third leading cause of death in the U.S.

That frustrates doctors no end, because while COPD isn't curable, it's largely preventable. Although genes play a role in the disease, about 85% of all cases in the U.S. are triggered by smoking. When cells are exposed to toxic substances for prolonged periods, they tend to become inflamed and swollen. In COPD, cells lining the lungs swell to a point at which they restrict the flow of air. "It's like a sunburn of the air passages," says Dr. Thomas Petty, a pulmonologist at the University of Colorado Health Sciences Center in Denver and at Chicago's Rush University. Swelling and inflammation trigger bronchiospasm, a clenching of the muscles surrounding the air passages, further choking off the oxygen supply. Inadequate oxygen in turn damages the alveoli, the sacs of cells that transfer oxygen into the bloodstream.

The best way to stop this vicious circle is to quit smoking. "If people stop smoking early on," says Petty, "their lung function actually goes up and stays up for five years." That's a lot easier said than done, considering how addictive tobacco is--and it's not an option for the 15% of COPD victims who don't smoke. But even for nonsmokers, it's important to identify the disease as early as possible as that's when drugs are most effective. And because people with COPD are especially prone to lung infection, they need to be vigilant about antibiotics and flu shots.