Emphysema's most common victims are older, white, male, from South or Midwest

December 22, 1992|By Knight-Ridder Newspapers

Detroit -- Twelve years after he kicked a heavy, lifetime smoking habit, Detroit Mayor Coleman Young still pays a big price.

Young has emphysema and intermittent bouts of bronchitis, a related respiratory ailment. Both are lung problems that leave him tired from activity that most of us take for granted, such as climbing stairs or sitting up.

Emphysema, an irreversible lung disorder, is very common among American smokers, says Dr. Kevin Grady, a pulmonary and intensive care specialist at Detroit's St. John Hospital.

Some 2 million Americans have the disease, according to a 1990 health survey from the National Center for Health Statistics. About 1.3 million are 65 or older, compared to 600,000 who are 45 to 64. It's more common among men than women, and among whites than blacks. It's also more prevalent in the South and Midwest.

It occurs when smoking or some other factor aggravates a destructive enzyme that damages air sacs in lungs. Over the years, as air continually becomes trapped inside the lungs, these air sacs stretch and rupture. That can cause the lungs to grow considerably beyond their normal size, says Dr. Barry Lesser, a pulmonary and critical care expert at Grace Hospital in Detroit. As a result, some people with emphysema develop barrel-shaped chests.

To understand what emphysema feels like, try this exercise from Dr. Bohdan Pichurko, chief of pulmonary medicine at Sinai Hospital, Detroit: Close one nostril, inhale deeply and breathe through the open nostril for a minute. "It's exhausting," he says. "It leaves them tired and unable to do any strenuous activity. For some, stair-climbing is a nightmare."

Most people with emphysema have been heavy smokers -- typically two packs a day for 20 or more years, says Dr. Pichurko.

The rest either have an inherited form of emphysema or developed a tendency toward getting it after childhood respiratory infections or exposure to damage in such jobs as coal mining and cotton milling, Dr. Pichurko says.

It's not known whether exposure to others' tobacco smoke causes emphysema, specialists say.

Mayor Young, 74, coughs a lot and breathes heavily, sometimes so audibly others near him can hear. After nearly 20 years in office, he has drastically cut back his public appearances, reportedly because he tires easily. His emphysema makes him vulnerable to flu, pneumonia and heart attack.

As people age, their lungs lose some ability to take air in and out. But heavy, longtime smokers lose almost half their lung capacity by the time they are 65. Those who stop smoking slow this deterioration and preserve lung function.

"If you stop smoking today, there are areas undergoing change that have not undergone final destruction that can revert to normal lung tissue," says Dr. Lesser of Grace Hospital.

Stopping smoking may not make people live longer, he adds, "but you'll be sicker more days if you continue to smoke."

Medicines to help widen air passageways, or reduce inflammation in the lungs, typically are prescribed. Yearly flu shots and pneumonia vaccines are recommended, and antibiotics or heart drugs sometimes need to be taken for bronchial problems or to help weakened hearts.

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