“Those damn cigarettes.”
During Johnny Carson’s final days, when he mustered enough strength to talk, he would repeat that phrase over and over. Carson, who died of emphysema last month, knew the damage done from a life of smoking in smog country — two strikes against his lungs, according to a pulmonary expert.
“A terrible one-two combination,” said Dr. Eric Ten Brock, chief of pulmonary and critical care medicine at Kaleida Health. “A lot of cigarette smoking and a lot of environmental pollutants contribute to obstructive lung disease in general.
“Some of my patients have grown up watching Johnny Carson,” Ten Brock added. “When they see he died of emphysema, they look at themselves: ‘If Johnny Carson can die of emphysema, that certainly means I can, too.’ And it scares people.”
Chronic Obstructive Pulmonary Disease — or COPD, an umbrella term that includes emphysema, asthma and chronic bronchitis — is a costly killer. Not only was it the fourth leading cause of death last year claiming the lives of more than 120,000 Americans, according to the American Lung Association, it annually costs the nation $37.2 billion — directly through medical expenses and indirectly through loss of work time and productivity. In addition, the number of people with emphysema increased from 2.3 million in 1982 to 3.1 million in 2002.
The typical emphysema patient is male between the ages of 50 and 70. Those who develop the disease have commonly smoked for a very long time, destroying the tiny air sacs called alveoli in their lungs. This damage leads to holes in lung tissue, and once that damage is done, it can’t be reversed.
Carson, diagnosed with emphysema in 2002, was often seen smoking on camera as he sat behind his desk on the set of the “Tonight Show.” His desk, coincidentally, was equipped with a miniature fan to dissipate the smoke, and while no one may know how many packs a day Carson smoked, his habit was no secret.
“Smoking is measured in pack-years,” said Dr. Celestino Pietrantoni of Buffalo Cardiology and Pulmonary. “If you smoke one pack a day for a year, it’s considered the equivalent of one pack- year. If somebody smokes two packs a day for 10 years, that equates to 20 pack-years. Generally, people who wind up with emphysema smoke a minimum of 20 pack-years.”
At age 70, William Bradford of Clarence has lived with COPD for 15 years. His two-packs-of-Luckys-a-day habit was exacerbated by his work as a laborer in commercial construction.
“I worked with cement a lot,” Bradford said. “I worked on a farm where there was a lot of grain dust. I breathed in foundry sand, and a lot of silicates from grinding and cutting concrete. Every time I turned around, I was doing something that wasn’t good for me.”
And still, he smoked cigarettes. No matter how severe the lung damage, medical experts stress the importance of quitting smoking.
“I always tell my patients that no matter how severe their lung damage is, if they stop smoking they will still have a benefit over the next few years,” said Ten Brock, past president of the New York State Thoracic Society. “A lot of people say: ‘Hey, the damage is done. I might as well enjoy what life I have left.’ That’s the wrong thing to say.
“When your lungs are affected adversely by cigarette smoke, the rate of decline is generally three times greater — three times faster — than the rate of decline of a nonsmoker,” Ten Brock noted. “If you stop smoking, the rate of decline goes back to that of a nonsmoker.”
Four months after Bradford finally quit smoking — July 1989 — he discovered he had COPD.
“I went outside to take a tree down in my yard, and I couldn’t breath,” he recalled. “I just couldn’t get my breath. It was around Thanksgiving. Within a week I met with a specialist, and he told me I had COPD. There’s really nothing they can do about it. They just make it livable. I take quite a bit of medication.”
Chances are Bradford had been living with COPD for some time. The insidious nature of the disease makes it a silent stalker. It sneaks up on people, developing gradually over years. Those bad colds accompanied by a heavy cough? The cough that has become permanent? All signs of lungs in crisis.
“It creeps up on you,” Ten Brock said. “It’s easy to attribute to other things, and you adjust your lifestyle to accommodate your disability. That’s another way of not appreciating how impaired you are. Some of these people, when they first present, have severe emphysema, and they never knew it.”
Relief from nebulizers
It’s a vicious cycle. People who have emphysema typically lose muscle mass. They become weaker, their lifestyle compromised. Winter creates havoc, causing inflammation of the airways, keeping those with emphysema on the inside looking out.
“Every year it gets worse and worse,” Bradford said. “You can’t operate out in the cold, and it gets to be panicky if you are too far from a warm area where your nebulizer is. All of a sudden you can’t stay out there any longer. Your heart rate starts increasing, you’re gasping — and you get in the house and sit down and use a nebulizer. And then you relax, and you have that sigh.”
Bradford has three nebulizers: one portable and two in the house in case one breaks. The medications he breathes through the misting treatment — a respiratory cocktail consisting of albuterol, ipratropium, budesonide and theophylline — takes about 10 minutes to inhale. During the winter, he treats himself five times a day.
Waiting for lung transplant
There is no cure for emphysema, but in some extraordinary situations, a lung transplant is prescribed, according to Pietrantoni.
Kurt Koerner is waiting placement on a lung transplant registry. His lungs have not been the same since one collapsed last year during a predawn ordeal that he described as “pure hell.” It started out as what Koerner thought was a gas pain, but no matter how many Tums he took, the pain intensified. He couldn’t breath. He could not move. With his wife upstairs sleeping, Koerner waited on the couch for six hours until he was taken to the emergency room.
“I was told to quit smoking, and I didn’t do it,” said Koerner, 50. “The collapsed lung is what did it. I smoked a pack and a half to two a day, Merit Ultra Light 100s. After 30 years, it was tough to quit.”
Koerner used to look forward to that morning cup of coffee and cigarette almost as much as he loved going to work at his own auto repair business, where fumes from exhaust and paint taunted his lungs daily.
“It’s the only thing I ever did in my whole life,” said Koerner. “I definitely miss it. It was a skill, laying on a nice paint job and taking a car from junk to looking brand new. Now I tire real fast.”
The lung collapse changed everything. Koerner couldn’t cut his grass. He couldn’t carry bags of garbage to the street. Stairs became painful to climb.
“I’m on all kinds of medication,” he said. “I kept on getting infections in my lungs, so they would put me on prednisone and now I have osteoporosis. My bones are bad in my hips and shoulders. I’m waiting on a call now for my last round of tests, and then they’re going to put me on the (lung transplant) list.”
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