The following twenty questions – with answers – provide an overview of NLHEP, the importance of lung health, and steps you can take to ensure the continued health of your lungs.
- What is the National Lung Health Education Program, (NLHEP)?
The NLHEP is a multi medical and respiratory therapy organization with governmental agency liaisonships that was initiated to promote lung health by educating physicians, medical professionals, patients, healthcare policy makers, healthcare agencies, and the public about chronic obstructive pulmonary disease, how to detect it in the early stages, and how to intervene to potentially prevent or slow its progression to a disabling disease.
- Why do we need the NLHEP?
Chronic obstructive pulmonary disease (COPD) is now the fourth leading cause of death in the USA, accounting for over 120,000 deaths annually and costing more than 30 billion dollars per year. It is extimated that over 16 million Americans have COPD. Yet because its prevalence is still rising (and it is under-diagnosed), it has been suggested that over 24 million Americans actually have COPD.
- What is COPD?
COPD is a group of diseases that includes chronic bronchitis and emphysema. The common characteristic of these diseases is obstruction to airflow out of the lungs. Other symptoms are shortness of breath (dyspnea), chronic cough, mucus production with cough, and/or wheeze. COPD, unlike many diseases, is easily preventable. It is a disease over which the individual has control, especially if detected early.
- Who gets COPD?
In this country, more than 85% of COPD is due to smoking tobacco. The remaining 15% is due to such factors such as previous serious lung infections and/or inhalation of fume-laden air that damage the lung or genetic abnormalities, like alpha-1-antitrypsin deficiency. Smoking-related COPD tends to run in families. COPD has been diagnosed in 16 million Americans. It is estimated that over 24 million people have COPD — meaning almost half of those with COPD do not even know they have it!
- What are the symptoms of COPD?
The most bothersome symptom of COPD that leads individuals to seek medical attention is shortness of breath (dyspnea) on mild exertion out of proportion to the intensity of the activity performed, or what is often described as the feeling of not being able to get enough air. At first, this symptom may be present only during exertion but later may be present all the time, even while sitting quietly. In the late stages, continuous oxygen and frequent hospitalizations may be necessary. Cough, wheeze, chest tightness and chronic mucus production are other common and often earlier symptoms of COPD.
- If I don’t have these symptoms, does that mean I do not have COPD?
NO. In the early stages, COPD is usually completely silent. You were born with extra lung reserve, so that you can lose a lot of lung capacity before you will notice it. In addition, many people in the middle stages of COPD adjust their exertion level (modify their lifestyle) without realizing it, to only take part in activities that do not cause shortness of breath.
- How can I know if I have COPD when it is in the silent stage?
The best single test for detecting early COPD is a breathing test called spirometry. Ask your doctor to test your lungs so you can know your lung numbers.
- What is spirometry?
Spirometry measures the amount of air that you can blow out of your lungs (volume) and how fast you can blow it out (flow). It is measured by having you take in the deepest possible breath, then blowing out as hard and fast as you can for six seconds or more. The machine then measures how much you exhaled in the first second, called the forced expiratory volume in one second (FEV1) and the total amount you exhaled in 6 seconds, called the forced expiratory volume in six seconds (FEV6). Your ratio is your FEV1 divided by your FEV6 expessed as a percentage.
- How do I get spirometry?
You should ask your doctor to order it for you. The equipment to perform spirometry is very simple and your doctor will likely have it in the office or send you to have the test in another location.
- If I smoke and my doctor listens to my lungs and orders a chest x-ray, is it still necessary to have spirometry?
YES. The physical exam and chest x-ray cannot detect COPD in the early stages of the disease. Spirometry can.
- If I do not smoke, do I still need spirometry?
Maybe. Spirometry should be performed in all smokers over 44, former smokers and also in people exposed to environmental tobacco smoke or irritants in the workplace or those with a family history of COPD. It should also be done in anyone of any age with a persistent cough, excess mucus production, wheeze, chest tightness and/or shortness of breath.
- How will I know if my spirometry test results are normal?
Normal values for the FEV1 and FEV6 vary, depending on your age, height, gender and race. Your numbers will be higher in comparison to others if you are younger, taller and a male. Also Caucasians have higher numbers than African Americans or Asians. Therefore, the numbers are presented as a percentage of the average expected in someone of your age, height, gender and race. This is called percent predicted. An FEV1 greater than 80% of predicted and a ratio of FEV1 to FEV6 greater than 70% is considered normal.
- What should I do if my numbers are abnormal?
You should talk to your doctor. There are many possible reasons for an abnormal test result, and your doctor may want to order more tests to find the reason. If you smoke, stop smoking. Stopping smoking is the single most important intervention you can make to improve lung and overall health.
- If my numbers show that I already have COPD, why should I stop smoking?
Scientific evidence strongly shows that stopping smoking at any time provides clear-cut health benefits. First, you can prevent further damage. When you stop smoking, your rate of lung capacity loss will likely return to that of a nonsmoker. Second, an abnormal spirometry result puts you at risk for early illness and death from all causes, especially lung cancer, heart disease and stroke.
- If I stop smoking, will my lungs look like that of a never smoker?
No. The damage from smoking may be permanent. Once people reach adulthood, the lungs stop growing and will not regrow. Even exercise and good diet, so important for your general health, will not cause your lungs to regrow. That is why you must start now to preserve the lung function you have.
- If my lung test numbers are normal does that mean I am safe from the affects of my smoking?
NO. You should be retested in 3-5 years. Your test results may be normal now, but can still become abnormal later. Smoking attracts inflammatory cells that release enzymes that destroy lung tussue. It may be a few years before enough damage has been done to be detected by spirometry. In addition, smoking puts you at risk for many diseases besides COPD, including cancers of the mouth, throat, esophagus, stomach and bladder, as well as heart disease, hypertension, stroke, peripheral vascular disease and leukemia. Smoking can also cause premature facial wrinkles and has been linked to impotence.
- Will all these diseases caused by smoking be detectable by spirometry?
Amazingly, spirometry results predict illness and death from all causes, even though it is a lung test. Abnormal spirometry results predict increased risk for premature death from heart disease, lung cancer and stroke..
- If my test numbers are abnormal, is there anything I can do to make them better?
You should talk to your doctor. What you can do to make your lungs better will depend on why your numbers are abnormal. Obviously, if you smoke, stop smoking. It is important to preserve the lung function you have. Certain medication may help to improve your lung function, depending on the cause of the problem. Although there is no current cure for COPD, many drugs can partially improve airflow obstruction and associated symptoms of COPD.
- If my numbers are abnormal, what else should I do to preserve my health?
Stop smoking. Eat a healthy diet. Exercise regularly, even if only moderately, under the direction of your doctor. Talk to your doctor about whether you should have the influenza vaccine every fall, the pneumococcal vaccine every five years, routine bronchodilators, maintenance inhaled corticosteroids, or antibiotics for acute worsening of symptoms.
- I have tried to stop smoking and couldn’t. What should I do?
You should still continue to try to stop smoking, but you may need some additional help doing it. Many people do. Ask your doctor to help you find the right smoking cessation program and, if necessary, the right nicotine replacement therapy or other medication to help avoid the urge to smoke and the withdrawal symptoms. Better understanding of what causes people to smoke has led to more effective therapy, including support groups, telephone “hot lines,” and most important of all, treatment using appropriate medications. Many smokers are truly addicted to the nicotine in cigarettes, and medication therapy can help them handle withdrawal symptoms.