Text: Paule Goumaz
Photo: Science photo library

When the lungs go up in smoke

Known as “smoker’s disease”, chronic obstructive pulmonary disease will be the third leading cause of death in the world in 2030. This article explores a type of respiratory disease that is not very well known.

Chronic obstructive pulmonary disease (COPD) develops silently over a period of years. Sufferers are unaware of their condition. COPD affects nearly 400,000 people in Switzerland, where tobacco use is the leading cause. Among non-smokers, microparticles in air pollution have become a well-documented risk factor in the past few years. “The inhalation of smoke or other irritating substances causes the bronchial tubes to contract and become inflamed, resulting in pulmonary obstruction and a diagnosis of COPD,” explains Alban Lovis, associate physician at the Lausanne University Hospital Pulmonary Service. “This same phenomenon causes pulmonary emphysema, or the destruction and dilation of the lung’s alveoli. The alveoli are no longer able to extract oxygen from the air we inhale so that it can be sent throughout the body.”

A diagnosis that comes too late

COPD symptoms include trouble breathing at the slightest effort as well as chronic expectorations and coughing. But symptom onset is insidious and very gradual. In the beginning, sufferers don’t notice the signs of the disease, then adjust to the changes. “Instead of walking up Rue du Petit-Chêne in Lausanne on foot, they take the metro,” says the lung specialist. “They think they can’t catch their breath because of their age.”

These symptoms should serve as a warning though, because they often mark the start of a descending spiral. In some serious cases, the patient can only walk a few steps at a time. “Because they are out of breath, COPD sufferers exercise less and less,” says Alban Lovis. “They no longer get out to do their shopping. They eat less, and lose muscle mass. They also become socially isolated because they are no longer strong enough to climb a
flight of stairs, for example.”

These symptoms should serve as a warning though, because they often mark the start of a descending spiral.

Because of their weakened state, these patients often contract respiratory infections. This can cause their health to decline to the point that they are at risk of dying. “Generally speaking,” says the specialist, “these patients come to see us when they are 60 years old. At that point, they are severely impacted already, with less than half their normal lung capacity.”

The specialist recommends visiting your GP if you use tobacco products, even if you aren’t experiencing early symptoms of COPD. The doctor can perform a spirometry test, which measures respiration, and provide advice about how to stop smoking. “Remember that one in two smokers dies as a direct result of tobacco,” says the specialist. “Only 20% of smokers develop COPD. But it’s vital that these patients receive an early diagnosis, because damage caused to alveoli and bronchial tubes cannot be reversed.”

Improved physical shape

The first step towards preventing lung damage is to stop smoking. Next, bronchodilators—medications that expand the bronchial tubes—help patients breathe more easily.

But doctors focus on a comprehensive approach to the disease. A rehabilitation programme followed at Rolle Hospital, for example, over the course of several weeks helps patients have a better quality of life. The course includes psychological support as well as exercises
and nutritional advice to help them regain muscle mass. “COPD patients can gradually reverse their decline in health,” says Alban Lovis. “By increasing their respiratory capacity, they regain confidence and can move more easily.” But they must continue their new, healthy lifestyle every day to stop the progression of COPD symptoms. While it is not the norm, some patients receive lung volume reduction surgery in addition to rehab. This procedure is
either performed surgically or endoscopically (see inset).

According to the World Health Organization, 64 million people throughout the world currently suffer from COPD. This figure is projected to rise. As a result, COPD is likely to be the third leading cause of death by 2030. “In developing countries, this disease is most commonly caused by burning wood and coal inside homes for heating and cooking,” says Alban Lovis. “In Switzerland, however, it’s the consequence of the smoking boom.” Even though it’s becoming less common, the effects of this silent killer will continue to be felt for many years.” ⁄



Reducing lung volume to breathe more easily

Patients suffering from severe pulmonary emphysema can undergo surgery to reduce their lung volume. “The destruction of alveoli makes the lung less elastic,” explains thoracic surgeon Michel Gonzalez. “The lung dilates and resembles a balloon that can no longer deflate.” This air bubble compresses the diaphragm and the surrounding healthy lung tissue until they can no longer move when the patient inhales or exhales. In such cases, the volume of the damaged lung can be reduced.

The operation is performed by thoracic surgeons or lung specialists. Thoracic surgeons remove the damaged portions of the lung through incisions made in the patient’s
thorax. Pulmonologists, however, use an endoscope to insert valves, which let the excess air escape the lung, or coils. These small spring-shaped structures compress the damaged area of the lung. “These treatments improve the patient’s respiration and therefore well-being,” says the surgeon. “But they are not palliative. They do not fix the damaged portion of the lung. To prevent COPD and its consequences, you have to get back to basics—which means getting rid of cigarettes!”