About 20% of adolescents and adults smoke. Most people start smoking in their teens and many continue the habit for a lifetime. But a short lifetime! Smoking on average reduces life expectancy by 14 years. While most of us can expect to live these days into our 80’s, smokers are more likely to die in their sixties and seventies! Close to half a million people die from smoking EVERY YEAR! And overall cost of care and lost ‘productivity’ – what industry and the overall economy loses because sick smokers cannot work, is close to $92 BILLION EVERY YEAR.
No matter how many times I look at these figures, they still amaze me. Any way you look at this, it is a national and a personal disaster. And a preventable one at that! That makes the disaster a full blown tragedy as well. It breaks my heart when I have to counsel families and patients that they are dying from smoking related disease. And the guilt and anger as all realize that this disease was caused by smoking – an avoidable habit!
I run a smoking cessation program. Hundreds of people come to see me who are smoking and want to quit. Many have tried 4, 5 or 6 times before. Some are young and realize the future consequences of continuing smoking. Sadly many are older, in their 50’s, 60’s and 70’s and they have been told they have a smoking related disease and MUST stop smoking to have any chance of living a productive life. Nearly all don’t realize when they see me that their life expectancy is already significantly reduced. However it is NEVER TOO LATE TO QUIT!!! At any stage of any smoking related disease, it is always better to quit than to continue. Every single cigarette damages further. And the moment a smoker quits, the moment the body can start to make a recovery.
Many patients I see are surprised at what diseases smoking causes. As far as I know, there is no part of the body that is not affected by smoking. Every single organ system is affected: lungs, heart, brain, kidneys, breast, gastrointestinal system, skin, muscle, bone to name but a few. Heart attacks, cancer of just about every organ, strokes, vascular disease of the legs and all major vessels. And to many, a little known entity or disease process called COPD – chronic obstructive lung disease. Many patients come to see me who are weak, get very short of breath when they exert themselves and find it hard to wash, dress, prepare a meal, walk outside because they get so fatigued, short of breath and exhausted. They have smoked, either in the past or currently and have been told by their Doctors they have COPD. Most of them have no idea what this is. They are prescribed medications – puffers and inhalers, similar to those used by people with asthma, and the lucky patients have Doctors who realize that Pulmonary Rehabilitation – a program designed to overcome the medical, physical and emotional problems associated with COPD – can be very helpful in restoring people to a functional, enjoyable and productive life.
I will talk more about Pulmonary Rehabilitation in a future blog. For now, I want to talk about COPD. Chronic Obstructive Lung Disease is one of the most common smoking related diseases – in fact, more than 85% of cases of COPD are caused by smoking. The remaining 15% is caused by pollutants and environmental fumes, as well as genetic disorders. Over 16 million Americans have been diagnosed with COPD and it is estimated that at least 25 million have it – that means there are millions who have COPD, suffer its consequences but yet have no idea they have it. Likelihood is these people continue to smoke, and so continue to damage their lungs.
When I am lecturing and teaching about COPD, I ask the Doctors and students what is the most common symptom – complaint – that patients with COPD present with: “shortness of breath”; “exhaustion”; “cough”; “sadness and depression”; “weakness in their muscles” are some of the answers I hear. And while these ARE some of the complaints that patients have, most commonly patients with COPD have NO complaints or symptoms!! None what-so-ever! This is best explained and understood using the concept of ‘reserve capacity’. Every organ system, when it reaches full size has way more capacity – function – than it needs at that moment in time. At any one time we use only a fraction of our brain tissue – so much of the brain is held back in reserve to be called into function only if other parts of the brain are injured. Living kidney donors can donate a kidney with out any loss of overall kidney function and a normal life expectancy. And our lungs have so much functioning tissue that it is not until over 50-60% of that tissue is lost or destroyed by smoking that symptoms such as shortness of breath, weakness and fatigue will develop. Sadly, by the time symptoms develop and so much lung tissue is damaged, further loss of lung tissue from whatever reason makes a significant impact on remaining lung function and accelerates the progression of symptoms.
So the most important message I can get across to the attendees at my lectures, and to the patients and families I see in my office is to recognize that any and all smokers most likely have COPD, and the absence of symptoms does not give reassurance that there is no COPD present. Stopping smoking is the single most important treatment for COPD. And helping smokers quit as early as possible is vital to limit the chances of developing COPD later in life.
COPD is an umbrella term for a group of conditions caused by smoking: chronic bronchitis and emphysema. Chronic bronchitis is a condition of airway inflammation with copious amounts of sputum being coughed up for many months a year, and many years in succession. At times the mucus is so voluminous and thick it blocks the airways in the lungs and oxygen can not get through these breathing tubes and into the body. Emphysema is a condition where the cigarette smoke destroys the lung tissue so instead of an abundance of lung tissue volume, more and more is destroyed and less is available for oxygen to cross from the lung airways into the blood vessels for distribution to the other body organ systems. The common pathway for these disease processes is lack of oxygen. Oxygen is essential for muscles, brain and all organ systems to make energy molecules that power all body functions: no oxygen – no energy molecules – no power – FATIGUE, SHORTNESS OF BREATH, NO ENERGY TO DO NORMAL DAILY FUNCTIONS, SOCIAL ISOLATION, DEPRESSION.
Treatment for COPD is multi-factorial: stopping smoking is most important and most effective in the long term. Smoking cessation programs, like the one I run at NYU Langone Medical Center are vital for successful quitting. Medications are essential – inhalers and puffers help open inflamed and tight lung airways. Antibiotics treat infections that often exacerbate COPD. Corticosteroids by pill and by inhalers decrease inflammation in the airways. Expectorants thin-out thick sputum and mucus making it easier to clear – cough out. Oxygen supplementation increases low oxygen levels and can be life saving when used for many years – oxygen always increases energy and reduces fatigue. Emotional support is very helpful and critical to improve quality of life. Relaxation therapies including visualization and meditation coupled with breathing re-training, help overcome the very distressing symptom of shortness of breath and the associated anxiety. Nutritional counseling is very helpful as patients with COPD can suffer either from overweight and obesity due to poor tolerance of physical activity, or from malnutrition due to poor meal tolerance and abdominal bloating from the accidental swallowing of air during breathing.
As well as smoking cessation in terms of its benefit in the management of COPD, Pulmonary Rehabilitation is essential to help people limited by their disease and symptoms restore themselves to wellbeing and function. I run a very active Pulmonary Rehabilitation program and it has been my pleasure and an honor to help so many people debilitated and limited in the community from COPD to recover strength and energy and teach them how to live more healthy and productive lives.
It remains my opinion that COPD – both chronic bronchitis and emphysema are vastly under-recognized and much more prevalent than currently believed. While we think of lung cancer, heart disease and stroke as being THE smoking diseases, it is COPD – the overlooked smokers disease, that I feel causes the most amount of smoking related disease and disability.
So live well and long by stopping smoking, start exercising and if you have COPD and want to protect your future, come see me!!
