MEDICAL MONDAYS: News Notes
Richard Parrish, MD, pulmonologist
Middle Tennessee Medical Center
TOPIC: Lung Disease Awareness
DATE: Monday, October 13, 2008
Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is a lung disease that makes it hard to breathe. It is caused by damage to the lungs over many years, usually from smoking.
COPD is often a mix of two diseases:
COPD gets worse over time. You can't undo the damage to your lungs. But you can take steps to prevent more damage and to feel better.
What causes COPD?
COPD is almost always caused by smoking. Over time, breathing tobacco smoke irritates the airways and destroys the stretchy fibers in the lungs.
Other things that may put you at risk include breathing chemical fumes, dust, or air pollution over a long period of time. Secondhand smoke is also bad.
It usually takes many years for the lung damage to start causing symptoms, so COPD is most common in people who are older than 60.
You may be more likely to get COPD if you had a lot of serious lung infections when you were a child. People who get emphysema in their 30s or 40s may have a disorder that runs in families, called alpha-1 antitrypsin deficiency. But this is rare.
What are the symptoms?
The main symptoms are:
As COPD gets worse, you may be short of breath even when you do simple things like get dressed or fix a meal. It gets harder to eat or exercise, and breathing takes much more energy. People often lose weight and get weaker.
At times, your symptoms may suddenly flare up and get much worse. This is called a COPD exacerbation (say "egg-ZASS-er-BAY-shun"). An exacerbation can range from mild to life-threatening. The longer you have COPD, the more severe these flare-ups will be.
How is COPD diagnosed?
To find out if you have COPD, a doctor will:
If there is a chance you could have COPD, it is very important to find out as soon as you can. This gives you time to take steps to slow the damage to your lungs.
How is it treated?
The only way to slow COPD is to quit smoking. This is the most important thing you can do. It is never too late to quit. No matter how long you have smoked or how serious your COPD is, quitting smoking can help stop the damage to your lungs.
It's hard to quit smoking. Talk to your doctor about treatments that can help. Using medicines and support increases the chance that you will quit for good. To learn more about how to quit, go to www.smokefree.gov, or call 1-800-QUITNOW (1-800-784-8669).
Your doctor can prescribe treatments that may help you manage your symptoms and feel better.
People who have COPD are more likely to get lung infections, so you will need to get a flu shot every year. You should also get the pneumonia vaccine. It may not keep you from getting pneumonia. But if you do get pneumonia, you probably will not be as sick.
There are many things you can do at home to stay as healthy as you can.
What else should you think about?
As COPD gets worse, you may have flare-ups when your symptoms suddenly get much worse. It is important to know what to do if this happens. Your doctor can prescribe medicines to help. But if the attack is severe, you may need to go to the emergency room or call 911 .
Understanding Lung Cancer - the Basics
How common is lung cancer?
Lung cancer is responsible for the most cancer deaths in both men and women throughout the world. The American Cancer Society estimates that 173,770 new cases of lung cancer in the U.S. will be diagnosed and 160,440 deaths due to lung cancer will occur in 2004.
Lung cancer was not common prior to the 1930s but increased dramatically over the following decades as tobacco smoking increased. In many developing countries, the incidence of lung cancer is beginning to fall following public education about the dangers of cigarette smoking and effective smoking cessation programs. Nevertheless, lung cancer remains the most common form of cancer in men worldwide and the fifth most common form of cancer in women.
Lung cancer has also surpassed breast cancer in causing the most cancer-related deaths in women in the United States.
What Is Lung Cancer?
Although lung cancer is the leading cause of cancer death in the U.S. in both men and women, it is also one of the most preventable kinds of cancer. At least four out of five cases are associated with cigarette smoking, and the cause-and-effect relationship has been extensively documented. During the 1920s, large numbers of men began to smoke cigarettes, presumably in response to increased advertising. Twenty years later, the frequency of lung cancer in men climbed sharply. In the 1940s, significantly more women became smokers. Twenty years later, there was a similar dramatic increase in lung cancer among women.
Lung tumors almost always start in the spongy, pinkish gray walls of the bronchi -- the tubular, branching airways of the lungs. More than 20 types of malignant tumors that originate in the lung itself -- primary lung caner -- have been identified. The major types are small-cell lung cancer and non-small-cell lung cancer. The more common non-small variety is further divided into squamous cell carcinoma, adenocarcinoma, and large-cell carcinoma.
Non-Small Cell Lung Cancer
Squamous cell carcinoma usually starts in cells of the central bronchi, the largest branches of the bronchial tree. It is the most common type of lung cancer in men and in smokers; it is the easiest to detect early, since its distinctive cells are likely to show up in tests of mucus samples. It also tends to be most curable if found early because it spreads relatively slowly.
Adenocarcinoma is the most common type of lung cancer in women and nonsmokers -- tends to originate along the outer edges of the lungs in the smaller airways. Adenocarcinoma often spreads to spaces between the lungs and the chest wall, and its typical location makes early detection difficult.
Large-cell carcinomas are a group of cancers with large, abnormal-looking cells that tend to originate along the outer edges of the lungs. They are the least common of the non-small-cell lung cancers.
Small Cell Lung Cancer
Small-cell lung cancer is the most aggressive form of the disease; it is also called oat-cell cancer because, under a microscope, its cells resemble oat grains. Like squamous cell carcinoma, this cancer usually originates in the large, central bronchi. It spreads quickly, often before symptoms appear, making it particularly threatening. It frequently spreads (metastasizes) to the liver, bone, and brain. Although responsive to chemotherapy, small-cell lung cancer is rarely ever cured because it usually is not discovered before it has spread.
About 170,000 people in the U.S. are diagnosed with lung cancer each year, most between the ages of 40 and 70. Only 1% of lung cancer patients are younger than 30, and only 10% are older than 70. The number of people that survive five years or more is increasing and now stands at about 15%. An individual cancer sufferer's prognosis will vary according to the type of lung cancer involved, the person's overall health, and the status of the cancer at the time of diagnosis.
What Causes It?
Most lung cancer is caused by smoking and as with any cancer, each person's genetic pattern influences susceptibility. The fact that lung cancer runs in some families suggests that a predisposition can be inherited. Additionally, certain genetic traits have been identified that make some people more susceptible than others to cancer-causing substances like those found in tobacco smoke.
Nonetheless, anyone who smokes one pack of cigarettes daily is 20 times more likely than a nonsmoker to develop lung cancer. For people who smoke more than two packs a day, the risk more than triples. Breaking the smoking habit reduces risk significantly, yet former smokers are always slightly more susceptible than nonsmokers. Secondhand tobacco smoke can also cause lung cancer, giving nonsmokers who live or work with smokers a somewhat higher lung cancer risk than those in smoke-free environments.
Cancer-causing substances other than those found in tobacco or tobacco smoke can also cause lung cancer if inhaled in quantity over time. However, experts disagree about how much exposure to specific cancer-causing substances is dangerous. Workers who are exposed on a daily basis to asbestos, silica, mineral dusts, coal dust, arsenic, or the radioactive gas radon are much more likely than the average person to develop lung cancer, especially if they are smokers.
Lung tissue that has been scarred by disease or infection, such as scleroderma or tuberculosis, is more susceptible to tumor growth. Because of a high frequency of lung cancer among people who eat large amounts of fat and cholesterol, some researchers speculate that diet may also influence lung cancer risk