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Friday, December 19, 2014         

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Getting tested early can ease pulmonary disease

By Dr. William Osheroff

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Chronic obstructive pulmonary disease consists of several diseases, including chronic bronchitis and emphysema. COPD blocks airways, making it difficult to breathe. It's the fourth-leading cause of death in Hawaii and the nation. COPD can't be cured but it can be managed. Getting tested early can help you keep the disease from worsening.

More than 85 percent of cases are due to smoking, according to the National Lung Health Education Program. Other causes include secondhand or environmental smoke, asthma, prolonged exposure to dust and chemicals, frequent respiratory infections or genetics. The prevention is not to smoke.

I remember a 45-year-old patient, Mark, who came in to talk about COPD:

Mark: Doc, my father recently died of COPD. I'm a smoker, and I'm worried that I'm heading down the same path.

Dr. O.: You're right to be concerned. COPD is extremely common and serious. Why do you think you're headed the same way?

Mark: My dad smoked a lot. It always sounded like he was coughing up something. As he got older, he became short of breath all the time and wound up on oxygen. I've begun to cough a lot, and sometimes cough up yellow phlegm.

A heavy smoker for 25 years, Mark had a history of coughing that seemed to be worsening. He felt OK during day-to-day activities but was short of breath during exercise or strenuous efforts. Although he had no severe symptoms, I was concerned.

Dr. O.: I'm afraid that your symptoms might be early indications of COPD. We should do a few tests. I'm going to order a chest X-ray and spirometry test.

Mark: What's that?

Dr. O.: It's a machine you blow into that records how much air you can exhale and how fast you do it. It's quick and easy, and the best way to diagnose COPD.

Mark scored below average for his age and size on the spirometry test, an indication of COPD or asthma. To rule out asthma, I had him use an inhaler, then repeat the test. When his reading was still below average, I had to give him the bad news.

Dr. O.: Unfortunately, your suspicions were correct. Your tests indicate that you are in the early stages of COPD.

Mark: Oh no. This is horrible news. I should have known better. I should have learned my lesson after watching my dad. What do I do now?

Dr. O.: A few lifestyle changes will make a big difference. The first step is to quit smoking right away.

Mark: Isn't the damage already done?

Dr. O.: It's never too late. By quitting now, you'll help lessen your symptoms and prevent further damage. And, as you know, there are lots of other health benefits.

We discussed symptoms he might experience, such as shortness of breath and lingering respiratory infections. We also talked about medicines that could help him manage the disease and the importance of routine spirometry tests to see how he was progressing.

I gave him information on a quit-smoking class and medicines that could help. We talked about other factors, like diet and exercise. I told him that carrying extra pounds puts additional stress on the heart and lungs. Exercising can help people lose weight and improve heart and lung function. It's also important to reduce the amount of salt you eat. Salt causes fluid retention and can raise blood pressure.

As I continued seeing Mark regularly over the years, I was delighted to find that he had quit smoking. He still showed many COPD symptoms, but he was fighting it the best he could and seemed happy and healthy. I will always remember Mark because he is a true example of how to keep a chronic disease from taking over your life.

If you are at risk for COPD, talk to your doctor about getting tested.

A spirometry test is the only way to confirm it. To reduce your chances of developing COPD, don't smoke. If you have COPD, HMSA's Care Connection disease management program can provide education and support.

The earlier the condition is detected, the easier it will be to manage. Talk to your doctor right away. It could be a breath of fresh air.

Dr. William Osheroff was a practicing family physician for 12 years before becoming a physician executive. In 20-plus years as a medical director, he has worked in Colorado, California and New York with various managed-care and insurance companies. He has been with HMSA for 10 years, serving as vice president and medical director.






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