Weill Cornell Medical Center Spotlights Chronic Pulmonary Disease
NewYork- Presbyterian Hospital/Weill Cornell Medical Center in collaboration with the National Heart Lung & Blood Institute (NHLBI) and NYC Department of Health and Mental Hygiene recently held a conference to raise awareness and understanding about what few know as the fourth leading cause of death in the US, Chronic Obstructive Pulmonary Disease (COPD), which is characterized by chronic cough, shortness of breath, and excessive sputum.
With numbers of cases rising, this debilitating and under diagnosed condition is expected, as indicated by Dr. Patricia Cassano, associate professor of nutritional epidemiology at Cornell University, to surpass stroke and become the third leading cause of death by the year 2010, preceded only by heart disease and cancer.
At the recent conference, panelist Dr. James Kiley, Director of the Lung Diseases Division at NHLBI, elaborated on the nature of COPD and the overarching goal of the “Learn More, Breathe Better” COPD awareness campaign, which is to enlighten health care providers, patients and the general public on the latest COPD research and the vital role of early detection. Dr. Kiley underscored the role of primary care physicians as “gatekeepers” who can increase patient knowledge of COPD.
“The strategic approach to this effort is to make sure that every person in this country understands what COPD stands for,” Dr. Kiley stated. Partnerships with private and public organizations have been formed to achieve this goal, with active use of media outlets. Ann Koppel, wife of journalist Ted Koppel, and recently diagnosed with COPD, has become an active participant in the campaign.
Dr. Cassano expanded on the discussion of COPD, highlighting the epidemiology of the disease. In addition to an expected rising death toll, Dr. Cassano stated that “mortality is the tip of the iceberg. It doesn’t tell the whole story behind the numbers.” That is, the quality of life for people living with this disease, especially in advanced stages, is quite low.
With patients learning to adjust to initial symptoms of COPD, diagnosis is not often given until advanced stages are reached. COPD thus remains under diagnosed with 12 million currently having the diagnosis, while according to a national survey, using breathing tests, 24 million actually have the disease.
The major cause of COPD is cigarette smoking, accounting for 85 percent of cases. Only 15-20 percent of smokers develop COPD, which has to do with the dominating presence of other major diagnoses, such as cancer and heart disease.
In the 10-15 percent of cases unrelated to smoking, approximately 30 percent are based on occupational exposure. In developing countries, where biomass fuel is used for cooking and heating, indoor pollution remains a contributor to COPD.
Outdoor air pollution poses a threat, especially for those suffering from heart and lung disease. Air pollution as a direct contributor to COPD is currently under investigation.
The death rate in women from COPD has been rising, and in 2000, the rate surpassed that for men; the assumption is based on an increase in women’s smoking rates beginning in the 1960s. Research has also demonstrated that women smoking the same amount of cigarettes as men suffer more damage, but upon cessation, have greater recovery.
Diet is currently being explored as an avenue of treatment through antioxidants. Cigarettes, which are oxidants, cause damage to lung tissue while anti-oxidants—whose sources include fruits such as blueberries and apples, and green leafy vegetables—can block damage of lung tissue. Dr. Cassano is currently working on a randomized clinical trial to determine the role of selenium and vitamin E in combination and separately in prevention of COPD.
Dr. Ronald Crystal, Chairman of Genetic Medicine and Chief of Pulmonary/Critical Care Medicine at NY- Presbyterian/Weill Cornell, focusing on the genetic background of COPD, reiterated that only 15-20 percent of smokers develop COPD; he hypothesizes a strong genetic component with reference to susceptibility to environmental stressors. While there are direct genetic causes of COPD, such as alpha-1 antitrypsin deficiency—a rare cause of COPD now treated by genetic therapy developed by Dr. Crystal—“for 99 percent of individuals with COPD the genetic basis is multi-genic.” Using a fibro-optic bronchoscope, the epithelium of airways can be sampled to determine the genetic component of the disease, which genes are being activated and which may be defending against disease. This technique allows for early detection of who’s susceptible to COPD, and subsequent administration of therapies such as the use of antioxidants. This method, however, is still in a preliminary state of use; the current general standard for detection is spirometry, a test to assess lung function by evaluating inspiration and expiration volumes. #
November is COPD awareness month. For more information visit www.learnaboutcopd.org.