Lung disease is the fourth leading cause of death among older Americans and one of the legacies of the popularity of smoking in earlier decades. About 16 million Americans have lung disease, and more than 100,000 die of it each year. About 80 percent of all cases of lung disease are related to smoking tobacco. Almost all other cases are caused by air pollutants. Lung disease typically occurs among individuals who have smoked at least a pack of cigarettes a day for 20 years or more. Symptoms of lung disease do not emerge until about 50 percent of the airways in the lung have been damaged. It can take two or three decades of smoking which is why the first signs of lung disease don't emerge until age 50 or older.

Lung disease is a progressive, irreversible and ultimately fatal lung disease largely of that is characterized by a gradual airway obstruction that impairs the flow of air into and out of the lungs. The impact of lung disease on health and function is substantial. Persons with lung disease are twice as likely to rate their health as fair or poor, nearly twice as likely to be limited in their daily activities, and see their physicians more frequently for medical care. In addition, lung disease significantly increases the risk of death from pneumonia and influenza.

The disease is manifested in two types:

Chronic Bronchitis is characterized by excessive sputum production and a chronic or recurring cough that persists for at least 3 months of the year for at least two years. The cough associated with bronchitis is caused by the effort to get rid of excess sputum. Seventy-five percent of people with chronic bronchitis are heavy smokers. The illustration below shows what a normal bronchus looks like compared to an inflamed bronchus.

Emphysema is a chronic lung condition in which the bronchioles (small air passages) and the alveoli (small air sacs) are destroyed. These changes cause abnormally large airspace in the lung in which expired air gets trapped and prevents new air containing oxygen from getting in. Emphysema causes shortness of breath and often a productive and wheezing cough. Individuals with emphysema may develop a barrel-shaped chest as their lungs become inflated with air trapped in enlarged air spaces. There is no cure for emphysema and it worsens over time. The illustration below shows the enlarged air spaces associated with emphysema versus the normal alveoli. To learn more about emphysema, click on the link for The American Lung Association.

Diagnosis

Early detection of lung disease is rare because symptoms occur so insidiously. Arterial blood gasses and pulmonary function tests (PFTs) are the cornerstone for assessing lung function.

Warning Signs of lung disease

• Shortness of breath, especially on exertion
• Wheezing
• Cough that lasts for at least a month
• Chronic mucus production
• Coughing up blood
• Weight loss
• Fatigue
• Cyanosis around the lips or fingernails

Treatment

Treatment of lung disease focuses on controlling symptoms, maximizing independence in ADLs, and reducing the frequency of hospitalizations. Many people with lung disease need suplemental oxygen help relieve the sense of suffocation. Other management strategies include inhalation treatments, and medications (e.g., bronchodilators, corticosteroids, etc.).

Another option for the most severe cases of emphysema is surgery, which has received renewed interest recently. Surgical procedures range from removing damaged lung tissue to create room for the rest of the lung to expand (i.e. called Bilateral Lung Volume Reduction), all the way to lung transplants. The National Heart, Lung and Blood Institute is currently conducting the National Emphysema Treatment Trial (NETT)

Prevention

Smoking is the major cause of chronic obstructive pulmonary disease (COPD). Once you quit smoking your risk of lung disease drops. Unfortunately, most smokers try to quit too late to prevent permanent damage to their lungs.

Risk Factors for lung disease

• Smoking
• Asthma
• Occupational exposure