Smoker? You might have COPD/Emphysema and not know it!

We all know the ill affects of smoking: cancer, stroke, heart attacks, emphysema, to name a few. What you don't know is that emphysema can sometimes unintentionally go missed for years.

First things first: Emphysema is the cousin of a condition called Chronic obstructive pulmonary disease [COPD]. Both of these are terminal illnesses from the day you are diagnosed. Emphysema and COPD have no cure, there is only life extension.

Now let me ask you this: what do you think when you hear emphysema?!? Probably some old person, still smoking, carrying around an oxygen tank, with tubing in their nose and talking in a raspy voice. This late stage reality does afflict a lot of pople however, on the flip side: a lot of smokers have early stage emphysema and don't know it.

Every so often I treat a patient who is suspected to have COPD and they are incredulous: "but I quit smoking years ago!" Leonard Nimoy probably went through a similar conversation.

After I explain that they have probably had it for years - the usual next question is: "How could my doctor miss this!? I have had x-rays done!?"

Sadly, unless you have bullous emphysema no x-ray or CAT scan will pick this up. You need something called Pulmonary Function Tests.

These tests help doctors figure out your total lung volume, flow volume ratio, response to inhaler treatments and a whole host of other things to determine if you have any disease or not. However, any lung problem (pneumonia, fluid buildup etc) can affect these numbers so the tests are only done when you are "not sick." Meaning, no insurance will cover this while you are hospitalized.

To make matters worse , while your aren't hospitalized, even if your doctor thinks you have it... Just being a smoker is NOT an indication to get these tests done. You need to have symptoms.

Meaning, your insurance will refuse to pay for these pulmonary function tests if your doctor tries to get them done for only a smoking history without any symptoms.

That's the catch: why would you even think to get these tests if you are feeling well AND if you or your doctor DOES think of them...without symptoms your insurance won't pay for them! This is why COPD goes missed for decades.

It gets even better... Like I said above.... There is no cure. So maybe you don't wanna know?!?

While it's certainly true that you will live longer if you quit smoking - what a lot of doctors don't tell their patients is that our treatments for it suck.

There are very few drugs for COPD that actually have a mortality benefit. Tiotropium is one,
Maybe inhaled steroids...the studies however, don't agree.

For the most part the drugs we use only keep you out of the hospital, they don't help you live longer. The thing that has been shown to help the most is quitting smoking.

However, even if you quit smoking the risk of developing COPD only decreases...it doesn't disappear.

Just like Leonard you could have not touched a cigarette for 30 years and it all catches up with you.

The tough part is explaining to patients that it's not actually "catching up" to them it's more likely been there all along but because you quit it was progressing very slowly and finally it got to a point that it's giving you symptoms.

Prior to it giving you symptoms you were too heathy to think about getting tested for it and now that you are hospitalized.... I CAN'T test you for it! A fun conversation to have with a sick patient right?!?

My advice: don't start smoking!