Wednesday, January 26, 2011

How just two cigarettes a day have left UK woman with COPD and facing a lung transplant

By SANDRA WALSH Mail online

When Carol Thomas decided to quit ­smoking she found it pretty easy. As a typical social smoker she’d never had more than a few cigarettes a day and, for months at a time, would not smoke at all.

Like many people, she assumed ­quitting would mean any damage to her lungs would be reversed.

But five ­cigarette-free years later, Carol was shocked to learn that her ‘habit’ had left her with an incurable lung condition — chronic obstructive pulmonary disease, known as the smokers’ disease.

‘It was a shock. I thought it was only people who’d smoked heavily for years who were at risk, or miners who’d spent their lives down the pits,’ says Carol.

‘The diagnosis terrified me — I was so young and yet I was told there was no cure, only ways of coping with the ­breathlessness and chest infections.

‘I felt ashamed, too, that I’d brought it on myself,’ she recalls.

Her case is far from unusual. Chronic obstructive pulmonary disease (COPD) — the umbrella term for lung conditions including emphysema and chronic ­bronchitis — is the UK’s fifth ­biggest killer, responsible for 30,000 deaths a year (which is more than for breast, bowel or prostate cancer).

Typically, COPD occurs in people over 35 who are, or have been, heavy smokers. But it can also affect social smokers and even those affected by passive smoking.

‘Any amount of smoking will damage the lungs,’ says Dr Nicholas Hopkinson, COPD specialist at the Royal Brompton Hospital, London. While this is the main cause, there are other factors, he says, including genetic susceptibility and ­working with certain chemicals.

‘As a result the lungs become damaged and inflamed, which causes a steady decline,’ explains Dr Hopkinson. ‘The problem is that most people don’t realize they have the disease until they’ve been admitted to ­hospital, by which time they’ve probably had around 20 years of lung damage.

‘People often put their breathlessness and chest infections down to age so don’t bother seeing their GP but, in fact, there’s nothing normal about being out of breath.’

Carol’s history is typical of many sufferers.

As a child growing up in Nottingham, she recalls her grandparents and ­parents smoking; as a young adult social events meant wading through clouds of cigarette smoke.

‘Everyone around me smoked; there was always someone with a cigarette in our house,’ recalls the 50-year-old. She herself started smoking as a teenager, although often went for months at a time without smoking at all.

But by the time she was in her late 30s, the mother of two had begun to suffer recurring chest infections. ‘At least twice a year I’d get really bad bronchitis and have to take several courses of anti-­biotics to get rid of it, but I just thought I was the sort of person whose colds went to their chests.’

‘I’d given up smoking at that point, but still got chest infections.’

One particularly bad infection in 2005 put her in hospital with ­pneumonia.

‘After I’d recovered, the doctor looked at my history and said: “There’s something not right here.” They did tests, including a CT scan, and found inflammation and permanent damage to my lungs. I was told I had emphysema, part of a group of illnesses known as COPD, and there was no cure.’

Further tests revealed that Carol had a genetic condition — Alpha-1-antitripsyn deficiency — which meant her body doesn’t produce a protein that protects the lungs from damaging enzymes.

Smoking accelerates the ­damage — a non-smoker with the ­deficiency would still suffer lung damage, but it might not show up until much later in life. Around one and two per cent of COPD cases have this genetic fault.

In many cases, the lung damage associated with COPD is triggered by tar in cigarette smoke.

This damages the cells lining the airways, causing inflammation; the protecting cells that go to repair the damage exacerbate the inflammation. As a result the ­airways narrow, making it harder to draw air into your lungs.

Meanwhile, chemicals in ­cigarette smoke destroy the ­elasticity of the tiny air sacs in the lungs — these sacs, called alveoli, transfer oxygen from the inhaled air into the bloodstream. The alveoli collapse, so less oxygen passes into the blood. Eventually, patients not only find it takes more physical effort to get air in and out of the lungs, but they also have to breathe more rapidly to get adequate oxygen.

Emphysema and chronic bronchitis are the two main conditions affecting sufferers of COPD, and usually come hand-in hand.

Emphysema refers to the air sacs losing elasticity, while ­bronchitis refers to the airways becoming inflamed and narrow.

‘You can’t reverse COPD but you can stabilize it,’ says Dr ­Hopkinson. ‘In the past 15 years there has been a lot of progress on treatment.

‘Stopping smoking is the single most important thing you can do. In most cases, it actually slows the progression of the disease.’

However, over the next few years Carol’s symptoms became so bad she had to give up her much-loved job at an energy company call center; she now struggles to ­perform even simple tasks such as walking up stairs and the weekly supermarket shop.

As a result of chest infections and bronchitis, she is admitted to hospital up to four times a year.

Even when she is well, she has to take 20 pills every day to help her heart and lungs cope with the strain, and is hooked up to an ­oxygen cylinder for three hours because her lungs are too weak to take in enough oxygen.

‘I’ve always been a positive, ­outgoing person but my ­confidence has been dented,’ says Carol, from Clifton, Nottingham.

‘I try to keep very active at home but tasks such as washing the floor knock me out for hours. I can never have cut flowers in the house because they can carry a bug called pseudomonas which has put me in hospital three times so far. And spray perfumes and deodorants are out as they irritate the airways and make my ­breathlessness worse.

‘But the worst things have been losing the job I loved and the fact that I can’t run around with my three lovely grandchildren.’

Carol’s diagnosis has had a profound effect on her husband of more than 30 years, Gary, and her sons, Clifford, 32, and Caine, 29.

‘They worry about me constantly,’ she says. ‘I try not to let it show how much the disease is affecting me, but it’s definitely getting worse, and it frightens me to think I won’t see my ­grandchildren grow up. I know it upsets my family to see me suffer.’

As with all COPD sufferers in the severe stages of the disease, ­Carol’s life expectancy has been dramatically curtailed and her symptoms are worsening as her lung function decreases.

Her experience should be a warning to all smokers.

As Dame Helena Shovelton, chief executive of the British Lung Foundation (BLF), explains: ‘There is a myth that you can smoke until you’re 40 and you’ll be fine, but it just isn’t true.

‘Early signs of the disease can be detected at young as 25 — any smoker over this age should be tested,’ she says.

The BLF, which campaigns on behalf of anyone with lung ­problems, regularly holds ­roadshows where a simple breath test reveals abnormalities in lung function. Called a ­spirometry test, it is also available in most GP surgeries.

Meanwhile, Carol Thomas is awaiting tests to see if she’s ­suitable for a lung transplant. She adds: ‘Anyone who smokes should come and take a look at a COPD hospital ward.

‘You see patients struggling for breath, wearing oxygen masks, barely able to move.

‘There’s nothing you can do to turn back the clock, but you can help yourself by not smoking and keeping away from anyone who does.’

For more information about COPD and other lung conditions go to

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