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COPD (Chronic Obstructive Pulmonary Disease)

prognosis

03/01/2010

Question:

My husband stopped smoking 4 years ago when he learned from his internist that he "probably" had a year to live. He had been diagnosed with emphysema 7 years prior to that. Well, he stopped smoking within one month of that prognosis and it is now 4 yrs later. He is on Advair and Spiriva twice a day. He saw a pulmonologist a few times (for the first time) about 2 years ago, but not since. He no longer coughs, but has very little stamina. He is and has been barrel chested for over 4 years. If he`s not working (he`s a physician), he`s sedentary. He weighs about 150 lbs and is 6`3", but he has always been extremely thin. However, he has not gained any weight since he stopped smoking. He engages in no physical activity of any kind, and has never been in a pulmonary rehab program. He used to golf, but has done little in the last two years. He golfed last summer, but was wiped out after 9 holes (using a cart). He is 64 y.o. and at the time he stopped smoking (a bit over age 60), he had been smoking 2 packs a day for over 35 years.

To help him stop smoking, he used the "nicotrol inhaler. Four years later, he still uses it (24/7), so he is still totally addicted to nicotine.

The smoking cessation seems to have clearly given him some additional years, but I wonder how much longer he has.

Answer:

Thank you for your inquiry. It is difficult to address any specifics regarding your husband's situation, without the benefit of an examination and some testing. It is helpful that he has quit smoking. Shortly after the point of quitting, the rate of decline in lung function is, on average, similar to that of a like-aged individual who did not smoke. There may, though, have been damage to his lungs during the time he was smoking. This damage may not be completely undone, if it is present. If he does have emphysema, the progression of the disease may be fairly slow if health is otherwise optimized and complications are avoided. There are options to improve symptoms and lifestyle for patients with many diseases. The progression of lung disease is optimally monitored on a regular basis, along with assessment of general health status and evaluation for the development other health problems. Medications should be monitored and adjusted to assure ongoing efficacy. Pulmonary rehab is often recommended to improve stamina, functional status, and symptoms of dyspnea. If oxygen levels are low, survival is improved with use of supplemental oxygen. Depression is often a contributor to patients' decreased activity level in the setting of chronic diseases, and is sometimes addressed through medications or counseling. There are occasionally surgical options that may be applied to address certain types of lung disease. These options may be explored by your husband through his physicians.

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Response by:

Amy L Pope-Harman, MD Amy L Pope-Harman, MD
Clinical Associate Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University