A Smoking Gun

By Richard P. Holm, MD
 
Mr. C, a 56-year-old fellow came into my office because he was experiencing shortness of breath with any exertion and was hoping we could fix it. He admitted that he has been smoking about one-and-a-half-packs a day for 40 years, and lately he’s been trying to cut down. Multiplying 40 times one-and-a-half gives him a 60-pack-year history of smoking, which is a lot. Also he’s inhaled to a lot of hog and hay dust over all these years.
 
He said his symptoms have been coming on over the last five years and now his heart beats fast with any exertion. His cough is getting worse, and for a year he’s been coughing up some pretty ugly stuff first thing in the morning, but the rest of the day he just can’t get it up. Lately, he’s been wheezing more and his chest gets tight, especially at night when he is trying to sleep.
 
Breathing tests demonstrated that he can inhale OK, but it takes some pushing and time to exhale. Blood tests showed high levels of hemoglobin, low levels of oxygen, and the chest X-ray showed over-expanded lungs. These are changes indicating the diagnosis of emphysema combined with chronic bronchitis, also called chronic obstructive pulmonary disease or COPD. This is not good news for Mr. C. because COPD is the third leading cause of premature death in the U.S. and a major cause for a miserable disability.
 
Normally in the lungs, airway tubes branch out, multiply, and become progressively smaller until they reach tiny air sacks called alveoli, which are covered with microscopic blood vessels. It is here where inhaled air touches blood. It’s the place of an almost magical switcheroo. Life giving oxygen is passed from air into blood in an exchange where the waste product carbon dioxide is passed from blood into air. With COPD, the walls of the tiny air sacks first lose their elasticity and then are destroyed leaving larger non-functioning cavities. Also, airways that are supposed to carry air to the alveoli become blocked because of inflammatory swelling and mucous.
 
Trying to help him, I encouraged Mr. C. to quit smoking, prescribed a medicine to help him quit, and provided an inhaler to turn off inflammation and dilate the bronchial tubes.
 
The end of this sad story is that he has a condition we can help, but not fix. And if he doesn’t stop smoking, I predict that it won’t be long before he will die, short of breath.