DEAR DR. ROACH: Please help me to understand what COPD means. – S.
ANSWER: “COPD” stands for “chronic obstructive pulmonary disease.” “Chronic” means it is long-lasting, and “obstructive” means the airflow in and out of the lungs is decreased. The three subtypes of COPD are chronic bronchitis, emphysema and chronic obstructive asthma. These conditions usually are progressive. COPD is the third leading cause of death in the U.S.
Chronic bronchitis is a chronic productive cough (specifically, lasting three months or more in two successive years). Smoking is far and away the leading cause of chronic bronchitis in the developed world, but home cooking fires are the cause in developing nations.
“Emphysema” means the destruction of the walls of the airways, causing abnormal, permanently enlarged air spaces. Smoking is again the leading cause of emphysema, but a genetic condition, alpha 1 antitrypsin deficiency, can bring about both emphysema and liver disease. People with this uncommon disorder sometimes mistakenly are assumed to be smokers.
Asthma is a common condition that is highly variable from person to person. Most people have reversible obstruction to the airway with exacerbations of asthma, but some people have a degree of obstruction all the time, and they are considered to have COPD.
COPD typically causes cough and shortness of breath, especially with activity. COPD often has exacerbations, which may be associated with infections, that cause worsening of symptoms, frequently requiring treatment, including hospitalization. Treatment for COPD is to remove any known cause (usually smoking, even secondhand smoke). Medicines to reduce inflammation (especially inhaled steroids) often are used, as are medicines to relax the muscles inside airways to relieve obstruction. In severe cases, oxygen is necessary. Lung surgery or transplantation is rarely used.
The booklet on COPD explains both emphysema and chronic bronchitis in detail. Readers can obtain a copy by writing: Dr. Roach – No. 601W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow 4-6 weeks for delivery.
DEAR DR. ROACH: I have Parkinson’s disease. Although my medication is still working, it’s not as effective as it was. I have heard this is the time to consider stem-cell treatment. Can you tell me if this is a good idea? – S.A.
ANSWER: Parkinson’s disease is caused by the loss of neurons (nerve calls) in a portion of the brain called the substantia nigra. Stem cells are early, unspecialized cells, capable of differentiating into any kind of cell. The theory with stem-cell treatment is that the stem cells will go into the affected part of the brain and take on the role of the damaged or destroyed cells. Some early work has been promising.
In my view, the technology is not yet ready for widespread clinical use. I don’t recommend it. There are many new medications for Parkinson’s disease, and I have recommended non-pharmacological therapy, including exercise, several times. I strongly recommend evaluation by an expert, preferably a neurologist experienced in Parkinson’s disease.
A reader recently wrote to tell me that treatment of his vitamin D deficiency greatly relieved his Parkinson’s symptoms.
Dr. Roach regrets he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to P.O. Box 536475, Orlando, FL 32853-6475.
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