Here are key takeaways from an episode of Kentukcy Health that examined types of lung diseases. Host Dr. Wayne Tuckson welcomed Dr. Wesley McConnell, MD, a specialist in pulmonary medicine at Kentuckiana Pulmonary Associates, and Deena Kinkade Adams, M.S. Ed., the executive director of the American Lung Association in Kentucky.
Asthma, COPD and other Lung Diseases Disproportionally Afflict Kentuckians
The number one symptom of lung disease that brings patients to Dr. McConnell’s office is shortness of breath. “If you can’t breathe, nothing else matters,” he says. “It’s like drowning but you’re on ground.”
According to McConnell, everyone begins to slowly lose lung function after age 28, but those suffering from lung disease have trouble with basic functions. “When you walk across the room and breathe – you’re fine,” he says. “But if you can’t get across the room because you’re huffing and puffing like you ran a mile, that’s not good. Or if you can’t get up a flight of stairs – or if you stop going up or down stairs because you’re short of breath.”
McConnell says that shortness of breath can be caused by diseases affecting other organs, particularly congestive heart failure which can lead to fluid buildup in the lungs. When he consults with a patient, McConnell will conduct a lung function test and check their history of exposure to tobacco, asbestos, and other risk factors.
The link between cigarette smoking and both COPD (chonic obstructive pulmonary disease) and lung cancer is well known. However, there are a myriad of risk factors for lung diseases, and some of them such as pulmonary hypertension are difficult to diagnose.
Pulmonary hypertension, where high blood pressure affects arteries in the lungs, affects two age groups, McConnell says: young women in their 30s and 40s, and then people in their 60s, 70s, and 80s who have connective tissue disease. McConnell, whose Kentuckiana Pulmonary Associates is an accredited pulmonary hypertension center, says that the only treatment available to his patients when the center opened in 1995 was a lung transplant.
Now, however, there are about 14 medications to help patients with pulmonary hypertension, McConnell says. “It’s a disease that causes high blood pressure in the lungs only, and eventually your right (side of the) heart fails,” he explains. “What we do with these patients is help them with their symptoms such as shortness of breath.” Despite improvement in treating the disease, McConnell says that unfortunately, survival rates for persons with this disease are only about 4 ½ years.
McConnell says that pulmonary hypertension is often misdiagnosed at first. People may present with shortness of breath and be diagnosed as having asthma – and he says that young women who present with symptoms are often told they’re being neurotic. Patients who have pulmonary hypertension see on average about five physicians before their condition is accurately diagnosed, McConnell says. His center in Louisville is one of 53 in the country devoted to treating patients with pulmonary hypertension and it also works to educate the public about the disease.
As for COPD, McConnell says that Kentucky leads all states in the U.S. with about 62 persons per 100,000 afflicted with the disease (Hawaii has the lowest rate at 38 per 100,000). “COPD has a range,” he explains, “there’s emphysema on one side, and chronic bronchitis on the other. Some patients have a pure destruction of the air sacs, which is emphysema…. People with chronic bronchitis are sort of on the other end, where they just produce a lot of mucous and can’t get it out and can’t breathe. Most people are not on the extremes, most people are sort of in the middle.”
McConnell notes that Kentucky’s long history of coal mining has led to high incidences of black lung disease among miners, although the rates have declined in recent decades as less people work in mining. “We also see a people with pulmonary fibrosis,” McConnell says. “Pulmonary fibrosis is a scarring of the lung and a destruction of the air sacs. When that happens it can be from a lot of different causes. One of them can be occupational, such as asbestos exposure. There’s been a lot done to try to mitigate those things, but it still does happen.”
Yet another lesser-known lung disease is intersitial pneumonitis, McConnell explains. This inflammatory disease with high mortality rate also destroys the lung sacs and it affects people ages 50 and older. McConnell says that there are drugs that can retard its progression, but the only way to fully cure the disease is by having a lung transplant.
Due to its location within the Ohio Valley, Kentucky is home to some of the highest asthma rates in the U.S. “Our air quality in the summer, as you know is very poor,” McConnell says, and that contributes to narrowing of the airways that are the hallmark of asthma. He adds that many asthma patients also suffer from allergies, which can intensify their condition. “Those people can really benefit from certain drugs we have that can suppress that allergy-type breathing problem,” he says.
McConnell advises patients who have occasional asthma to get it treated as soon as possible. “We know if people that have asthma for a long time don’t get medical care, they end up with COPD,” he says. “Because their lungs get so inflamed from the recurrent bronchial spasms, [it becomes] a fixed obstruction like COPD. With asthma normally the airwaves open back to normal in between attacks, but if you have attacks over and over again and you don’t get treatment, you’ll end up with COPD or lung function like someone who smoked 30 years.”
For COPD patients, McConnell says that supplemental oxygen can be beneficial. “In those patients, the oxygen can help them do more – we want patients with COPD to be active. We want them to learn breathing techniques. Because what happens is, when you start having trouble with your breathing, you spend more energy breathing than you do with just about anything else. And we know that if we can increase your muscle mass and have good nutrition you can do more and can get more out of (the lungs). We really encourage exercise and pulmonary rehabilitation, which is an exercise program designed just for people with lung disease.”
Fighting Lung Disease Through Outreach and Prevention
“The American Lung Association – there’s no place it’s more needed than the state of Kentucky,” Deena Kinkade Adams says. “Our lung cancer rates are the highest in the nation, we’re in the top group for smoking rates. Radon is in Kentucky in addition to smoking.”
Adams says the Kentucky chapter of the ALA offers a multitude of programs to people all across the state. Several of them involve smoking cessation, including one called Not On Tobacco that’s designed for young people and their parents. “Smoking is our number one problem in the state if you ask me,” McConnell says. “I think that 28 percent of our adult population still smokes, we’re the highest in the country, and if you look at our COPD rates, we’re number one.”
Another nationwide program that Kentucky participates in is Fight for Air Climb. “The Fight for Air Climb is a signature event for the American Lung Association,” Adams says. “It’s held in about 45 major cities across the United States. And the goal is to help people understand what it takes to be active.” In the Fight for Air Climb, participants including police officers and firefighters climb the stairs of a local skyscraper – in Kentucky’s case, the PNC tower in Louisville – to the top to help them understand what it takes to achieve good lung performance, Adams says. It’s one of the ALA’s leading fundraising events as well.
Good air quality is essential to preventing lung disease, Adams explains, and in years past the ALA in Kentucky has worked on projects such as the Air Louisville Project, where persons attached a GPS to their asthma inhalers to keep track of what part of town they were in when they had to use them.
“More recently, we have supported the Green Heart Project with some planting to determine the impact of green space on compromised areas in Louisville,” Adams adds. According to data from this project, the tree canopy in the Derby City is only 37 percent.
“If you look at research, trees help get rid of ozone,” McConnell says. “Ozone is the one thing that can trigger asthma and COPD exacerbations… There’s an effort going on now to increase the trees in our community. We lost some in a tornado years ago, our trees are aging, and we have a lot of neighborhoods where people can’t afford to plant a tree.”
Adams says that the ALA’s mission is to spread awareness and education about lung health to the population. Their Asthma Basics program is designed to inform parents about the disease and how to help their kids when they have an asthma attack. “We also have Better Breathers clubs from one side of Kentucky to the other,” she says. “Those are for people who have lung disease of all kinds, and they get together and share stories as a community of people with the same problem.”
Responding to a rise in lung cancer incidence rates for young women, the ALA started its Lung Force initiative about six years ago, pledging about $12 million to fund research into improving diagnosis and treatment for the disease. One aspect of outreach that is becoming more widely known involves informing smokers about early screening options for lung cancer.
“What most people don’t know is that, if you have Medicare, Medicare will pay for a low-dose CT scan to screen for lung cancer,” McConnell says. His clinic participated in a national CT scan screening study several years ago, which found that some, but not all, smokers could benefit from getting the scan during the early years of their habit. “But the problem is, we don’t have enough of those done in our state, or nationally, really,” he says. “What we find is that people forget about it – physicians are not on top of the statistics. There are lung doctors out there, and I’m just as bad as anyone else, who think about why a patient is coming in for shortness of breath, and are not thinking prevention.”
McConnell says by using the low-dose scans his clinic has caught lung cancer early in many patients. He adds that folks under 65 who are not on Medicare can get the scans for around $200 at two businesses in Louisville. Adams says that the ALA guidelines for the scans are being age 55 or older and either a smoker or former smoker who smoked a pack a day for 30 years or two packs a day for 15 years. “Our frustration right now is that excludes some individuals who very well may benefit from that screening,” Adams says.