The Other Lung Disease

By Michael D. Lemonick Monday, Apr. 12, 2004
    • KERI PICKETT FOR TIME

    BREATHLESS: Lung damage keeps Bernard Regeth from working with horses, as he once did. Even ordinary chores leave him gasping

    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)?


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    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.

    But while early diagnosis is crucial, it rarely takes place. By the time symptoms like shortness of breath appear, the illness has usually been progressing for a decade or two. "It's like the brakes on a car," says Dr. Michael Stulbarg, chief of clinical pulmonary medicine at the University of California, San Francisco, Medical Center. "You don't realize the damage they're enduring in normal use, and then at some point they just go out on you."

    The only surefire way to identify COPD is with a C.T. scan, but few insurance companies cover such an expensive test for a symptom-free patient. There's another highly reliable technique, however, that's a lot cheaper: a $1,000 cell-phone-size device, known as a spirometer, that measures lung function. Unfortunately, says Petty, most doctors don't own a spirometer, and have probably never used one. "It's ridiculous," he says. "Doctors do bone scans and every everything else, but no spirometry."

    That could change if patients demand routine lung tests, but most are unfamiliar with COPD. "We've been our own worst enemies in the medical community — using so many different names for what we're talking about," says Sonia Buist, a pulmonologist at the Oregon Health Science University. Patients have heard of emphysema, the old-fashioned name for end-stage COPD, but it's stigmatized as a self-inflicted disease. "They feel guilty about it," says Dr. Stephen Rennard, a pulmonologist at the University of Nebraska Medical Center in Omaha, "and so they don't complain much." They also don't generate the kind of sympathetic funding that goes to more presentable diseases. People with advanced COPD "aren't cute," he says. "They're suffering and miserable."

    COPD victims do have some new treatment options, however. These go beyond the traditional bronchodilator drugs, which are used to relax the bronchial tubes and increase airflow, and the more radical lung-volume-reduction surgery, which removes the most damaged tissue to give the rest a chance to work more effectively. Inhaled steroids, for example, can reduce inflammation. Even more promising is a new class of medications called PDE4 inhibitors, now in clinical trials, which not only appear to fight inflammation but also may slow the progress of the disease. Yet another group of compounds, called retinoids, may even help damaged lung tissue grow back.

    Victims can do plenty to help themselves. Because exercise makes COPD patients short of breath, says Stulbarg, "they turn into couch potatoes. And when they finally do exercise, the symptoms are even worse." Whether you have COPD or not, exercise is the best way to build endurance. "You push yourself," he says, "and gradually your limits increase."

    Stulbarg showed in a recent study that even simple walking can help reduce COPD symptoms. Another study is looking at the possible benefits of yoga. Says co-investigator Virginia Carrieri-Kohlman of the University of California, San Francisco, School of Nursing: "We've got 70-year-olds who are on oxygen, and they're able to get down on the floor and do some breathing and do the poses."

    So while there's still no cure in sight for COPD and while folks like Bernard Regeth won't ever get back to their old selves, they have more options than ever for keeping the illness from completely destroying their lives. And if doctors and patients paid a little more attention to prevention and early treatment, the fourth leading killer in America could start dropping, rather than rising, in the charts.