Three years ago, Doris Rheaume, a retired addiction counselor who lives in Needham, Mass., could barely breathe.
"I was on oxygen 24 hours a day," she says. "If I turned my head without it, I huffed and puffed."
There is no mystery about why Rheaume was so sick. Now 71, she had smoked "a few packs a day for many, many years." And, like 15 to 20 percent of smokers, Rheaume has paid a terrible price for her habit: COPD, chronic obstructive pulmonary disease. Patients have chronic bronchitis (inflammation of bronchial tubes), emphysema (destruction of the tiny air sacs in the lungs) or both.
Better drugs, daring surgery and better pulmonary rehabilitation are improving the outlook and quality of life for many people with the disease.
But it remains a miserable condition in which sufferers slowly suffocate to death over many years. The lungs swell and lose their normal elasticity. Stale air gets trapped in over-inflated air sacs. By using accessory muscles, people inhale, with effort, but exhaling is nearly impossible.
People with severe cases "can't get a whole sentence out without taking a breath," says Dr. Gail Weinmann, director of the airways biology and disease program at the National Heart, Lung and Blood Institute.
According to the U.S. Centers for Disease Control and Prevention in Atlanta, 10 million Americans have been diagnosed with COPD and 14 million more have somewhat impaired lung function. The death toll is 120,000 Americans a year - and rising.
In COPD, as in asthma, the big culprit is inflammation of the lungs and airways. White blood cells pump out chemicals called cytokines that cause mucus glands to produce excess mucus. Inflammation also leads to scar tissue that makes the windpipe more rigid, which makes breathing harder.
In the delicate air sacs of the lungs, inflammatory cells pump out digestive enzymes that eat away lung tissue. The air sacs get larger and their number decreases. Surface area decreases, and air gets trapped inside.
So, what to do? First, if you smoke, stop. Some loss of lung function is normal with aging, but COPD speeds up that decline, says Dr. Gregory Diette, an epidemiologist at the Johns Hopkins University. Second, get influenza and pneumococcus vaccinations to avoid bronchial infections. Third, exercise, but when air quality is good.
