Check Out That Wheeze
It is not a deadly illness. It's two of them. Chronic obstructive pulmonary disease, which kills 60,000 men every year, is a catchall ailment made up of emphysema and chronic bronchitis, sometimes complicated with asthma. What these ills have in common is an insidious destruction of the lungs, leaving sufferers gasping for air. Another feature they share is lethality for men. The death rate is almost 1.5 times higher than it is in women.
"The decline is so gradual that you don't notice it," says Douglas Fraser, who was diagnosed 15 years ago. "First you can't run anymore. Then you can hardly walk. I used to love to walk," says the 88-year-old former United Auto Workers president, who now totes oxygen everyplace he goes. "On Labor Day, I was able to walk five aisles at the supermarket. That was encouraging. My advice is, the earlier you attend to this disease, the better."
Advance work. As with many diseases, the earliest step to take is to avoid the risks. The illness--known as COPD--comes from irritating the lungs. In 8 of 10 cases, the irritant is tobacco smoke. Fraser was a three-pack-a-day man for 30 years. Jobs that expose people to irritants like asbestos are another risk. (These are habits and jobs dominated by men, one reason for their higher death rate.) There are also genetic risks in some cases. One is a deficiency of a crucial enzyme called alpha1-antitrypsin. This can be detected through a blood test, and sufferers can take a replacement enzyme as therapy.
And watch for symptoms. "A frequent cough that brings up a little phlegm isn't normal," says Paul Kvale, president of the American College of Chest Physicians. "Neither is shortness of breath." These signs call for a simple test. "Any primary-care physician should have a little device called a spirometer," Kvale says. "It's a tube, and you blow into it to measure how much and how fast you exhale. This test, with your medical history, is the best way to detect COPD."
Early detection may also help slow the disease. A new study, published this month in the Annals of Internal Medicine, showed that a drug called tiotropium (sold under the brand name Spiriva) cut down on the number of severe episodes of COPD among a large group of men. The drug keeps the airway expanded. Over time, it might slow lung deterioration. "We've not really had anything like this before," says pulmonologist Gerard Turino, director of the lung center at St. Luke's-Roosevelt Hospital in New York City. "It's very encouraging." Other drugs for COPD--like the bronchodilator Albuterol or corticosteroids--ease attacks but don't seem to slow the destruction of lung tissue.
As breath gets shorter, the list of therapies gets longer. Bronchodilators come first, and then inhaled corticosteroids can be added. Then come oxygen therapy and a comprehensive treatment plan called pulmonary rehabilitation that focuses on physical conditioning and reducing stress on the lungs. But COPD, by this point, is a downward path. "I think people--and doctors--need to realize now how serious this disease is," Kvale says. Waiting breathlessly to find out is not a good idea.
On The Horizon
Three new ways to heal damaged lungs are being tested:
Combo therapy of inhaled corticosteroids and bronchodilators may have a synergistic effect--the drugs together are more powerful than either one alone.
Anti-elastases are synthetic proteins--so far tested only in animals--that may stop lung tissue breakdown.
Lung reduction surgery may help patients with localized emphysema by removing the problem region. New surgical techniques to minimize the incisions may improve outcomes. -J.F.
This story appears in the September 26, 2005 print edition of U.S. News & World Report.
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