The three leading causes of death in our society are heart disease, cancer, and strokes.  The fourth leading cause of death from disease in our country is chronic lung disease.  In the year 2000 it accounted for 120,000 deaths.  Prior to a person passing away from chronic lung disease there is usually a long period of recurrent infections, shortness of breath and disability related to the disease.  Anyone with this problem or anyone having a loved one with this problem will testify to how unpleasant chronic lung disease can be.

     There are two basic kinds of chronic lung disease.  The first of these involves the actual breakdown of lung tissue so that the millions of tiny air sacs become fewer in number.  The fewer air sacs are somewhat larger but they are inefficient in exchanging oxygen and carbon dioxide.  This condition is called emphysema.

     The second problem that can happen in lung disease is obstruction of the airways leading down to the tiny air sacs where gas exchange occurs.  This can result from the airways having too many secretions or from the airways swelling in response to an inflammation.  This condition is called bronchitis.  When the problem occurs all of a sudden such as with a cold, we call it an acute bronchitis.  Instead when the problem has been going on for months and years such as occurs with asthmatics or cigarette smokers, the condition is called chronic bronchitis.  In a healthy non-smoker, acute bronchitis will generally clear in a week to ten days.  But if the patient is a smoker, the raw, irritated surfaces in the lung become inflamed and more irritated by the cigarette smoke and the condition can become chronic.  In this situation, the person develops a long-term cough productive of a purulent sputum and shortness of breath.

     We learn a great deal from genetics and the study of hereditary diseases.  Slowly leaking into our blood is a protein called trypsin which digests protein.  As you might imagine, if not neutralized this protein can digest us.  To combat this, in a normal person’s blood is another protein called anti-trypsin.  When trypsin appears, the anti-trypsin in our blood neutralizes it and prevents damage to the normal tissues.

     There is an hereditary condition called alpha-1-anti-trypsin deficiency.  In this conditionthe patient lacks the trypsin neutralizing protein.  Apparently, one of the most sensitive organs to this deficiency is the lung. This results in early and severe emphysema as lung tissue is progressively damaged.  If a person has alpha-1-anti-trypsin deficiency and is a smoker, death from emphysema can occur in the 30 year old age group.  This is a relatively rare condition but I have seen it several times in my practice in central South Dakota.

     While pneumonia involves an infection in the lung, generally it is completely cured and leaves no residual problem in most people.  However, if a person has chronic obstructive lung disease curing the pneumonia becomes much more difficult and the condition is frequently recurrent.

     Opportunities to treat chronic obstructive lung disease come at many levels.  If the person has asthma, removal from the contaminated environment causing the problem will often completely reverse the asthmatic condition. I remember being in Tokyo in 1970 with the United States Army.  We had a condition there called “Tokyo-Yokohama asthma”.  It was due to the very contaminated atmosphere of 11 million people all with cars sitting in a bowl-shaped valley with very contaminated air.  When our United States personnel and their families would leave the area, their Tokyo-Yokohama asthma would completely go away.  Thus removal from a contaminated atmosphere can make a big difference.

 In central South Dakota, our air is very clean and industrialization or auto exhaust contamination is not an issue.  However, cigarette smoking is a major issue and a form of air pollution.

     The second level of treatment for chronic obstructive lung disease is the use of a “bronchodilator”.  These are mists inhaled with special medicine that relaxes the muscle constricting down the air passages.  Albuterol is the most common of these products and can be used either with a small handheld inhaler or with a larger desktop handheld nebulizer for more severe cases.

     The second level of treatment for chronic obstructive lung disease is the use of a product called Atrovent (ipratropium bromide).  This product cuts down the amount of secretions released into the air passages.  With fewer secretions in the air passages, there is more room for air to go by and shortness of breath is improved.

 The third level of treatment for people with lung problems is the use of antibiotics when an infection occurs.  When the amount of secretions and sputum that the person is producing increases and the material becomes purulent and infected, an antibiotic is an indicated step.  Sometimes people with severe chronic lung disease are treated for ten days each month with a different antibiotic as a non-specific suppressant for infection.  This often works very well to keep people from getting recurring pneumonias.

     The next treatment available is a product called Singular.  This drug inhibits the production of inflammatory hormones that generate the chronic lung disease.  It works very well as a preventive but has no role in the person who has become suddenly severely ill with bronchitis.

 When a person’s lung disease has become more advanced, the use of cortisone is often a significant help in alleviating the shortness of breath and cutting down the amount of inflammation in the lung.  Often, very large doses are used in the person who has become suddenly severely worse due to an infection in the setting of their chronic lung disease.

     Lastly, oxygen maybe very helpful in alleviating the symptoms of shortness of breath that comes with lung disease.  In addition, it can be very important in improving mental function in those patients whose disease is so advanced that there is not enough oxygen to support the brain.  It is now been shown clearly that individuals needing oxygen treatment do better using the product all of the time instead of on an “as needed basis”.

     The healthcare professionals at your local clinics are well aware of treatment options for people with chronic lung disease.  Unfortunately, it continues to be one of the most common illnesses for which individuals come to a clinic.  Most of the time, some improvement or even relief or symptoms can be achieved with the use of the above medications.