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'Slow suffocation'
Chronic lung disease 'just goes on forever'
Connie Midey
The Arizona Republic
Aug. 30, 2005 - Les McGahan always loved running on the beach. Today he walks, an oxygen canister slung over his shoulder, when he visits his children and grandchildren in the Pacific Northwest.
"I used to be an avid outdoorsman," says McGahan, 76, of Gold Canyon. "I hiked and ran and fished. Now I can't do the things I used to do."
McGahan has chronic obstructive pulmonary disease, a condition marked by a gradual loss of lung function. It's the third-leading cause of death in Arizona, the fourth-leading cause in the United States.
The term COPD describes the obstructed airflow found in emphysema and chronic bronchitis, separately or in combination.
Some doctors, including University of Arizona researchers, believe asthma also is linked to COPD. According to a 20-year UA study published last year in the medical journal Chest, asthma patients were 12 times more likely than non-asthmatics to develop COPD later in life.
A former smoker and lung-cancer survivor, McGahan has emphysema and asthma.
Paula Shoup, 68, of Phoenix, who suffers from emphysema and bronchitis, has been treated for COPD since April 2004. That was four months after she quit her 30-year smoking habit.
"Anytime I see anyone smoking," she says, "I want to say, 'I wish you wouldn't. If you knew what I know, you wouldn't do it.' "
COPD, which can be controlled but not cured, is preventable for most people: Smoking is responsible for 80 to 90 percent of cases, the American Lung Association says.
Other risk factors may include secondhand smoke, genetics, occupational dusts and chemicals, air pollution and a history of childhood respiratory infections.
The breathing difficulties typical of COPD develop "either because patients' airways are so narrow that it's hard to get air in and out, or because lung tissue has been destroyed," says physician Richard Helmers, a pulmonary critical-care specialist at Mayo Clinic in Scottsdale and Phoenix.
In emphysema, smoking or another factor destroys elastic lung tissue, he says. Holes develop in the tissue, and the lungs become less able to transfer oxygen to the bloodstream, causing breathlessness.
"What I was taught when I was in medical residency," says Helmers, president of the Arizona Thoracic Society, "is that the bad thing about emphysema is that not only do you die sooner, but that in the last couple of years you wish you were dead."
Asthma, which sometimes co-exists with COPD, is an inflammatory disorder in which the bronchial passages are narrowed by tissues swelling from the inside and muscles constricting from the outside. Mucus produced in response clogs the airways even more.
Physician Rick Robbins of the Carl T. Hayden VA Medical Center in Phoenix says COPD-related asthma differs from the asthma seen in younger patients. In COPD, "asthma" means simply that the patient responds to a bronchodilator, an asthma medicine that improves airflow by widening air passages and relaxing bronchial muscle.
"A 20-year-old girl with asthma, you can make her better," Robbins says. "But you can only partly make a COPD patient with asthma better."
Chronic bronchitis, the other COPD condition, occurs most commonly when cigarette smoke has inflamed the bronchial tubes. Chronically swollen and narrowed bronchi restrict the flow of air between the windpipe and lungs. Excessive mucus is produced, and an irritating cough develops.
Combined, these conditions create the perfect breeding grounds for infections, so McGahan and Shoup take antibiotics at the first sign of one. Shoup has been treated for bronchitis twice this year, and breathes easier every day with the help of inhaled medications.
"I had a breath test not too long ago," she says, "and my doctor said my COPD is fairly mild. But I've learned that the really hot, hot heat bothers me more, so I've been going to our community swimming pool and walking in the water lately."
McGahan, who smoked for about 48 years before quitting eight years ago, also does water aerobics, with a group of men who call themselves "the geezer jocks."
Exercise, including breathing exercises, and a nutritious diet sometimes are prescribed to help people live more comfortably.
"I eat a lot of fruits and vegetables now, too," McGahan says. "My blood pressure has gone way down, and I think the aerobics and the diet are responsible for that."
He doesn't cough often, but the oxygen goes with him when he expects to do a lot of walking.
"I'm kind of like Linus with his blanket," he says. "It makes me feel pretty good."
Before McGahan's COPD was diagnosed, walking the length of the motor home he and his wife, Bonnie, vacationed in exhausted him.
"It's slow suffocation, is what it is," he says.
Treatment, which may include a lung transplant or lung volume reduction surgery in serious cases, allows some patients to continue their regular daily activities, Helmers says. Others make adjustments, and some become housebound.
At the VA hospital, Robbins sees people severely limited by COPD.
"It can be tragic," he says. "This disease just goes on forever."
He also sees a different mix of patients these days, as the number of women who smoke has increased. "COPD has gone from being an old man's disease to being a woman's disease, too."
Shoup's husband, Ron, still smokes cigars - outside only - and one of their adult children smokes occasionally, "but I know nagging doesn't work," she says. She hopes they don't have to get sick like she did before they're able to quit.
McGahan says he sometimes thinks about how different his life would be today if he hadn't started smoking as a college student.
"This disease takes your life away from you," he says. "And even when you're living, it takes your quality of life away."
Reach the reporter at (602) 444-8120 or connie.midey@arizonarepublic.com.
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