Life and Breath Preventing, Treating, and Reversing Chronic Obstructive Pulmonary Disease

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Chapter 1 Introduction I recognized Maxwell Harris immediately. It had been more than twenty years since I had been an undergraduate in his political science class. On a Columbia campus filled with intellectual all-stars, Maxwell Harris was a legend. He had been an advisor to every President since John Kennedy, and his bestselling books were classics in their field. But it was his personality and style that packed each seat in the large lecture hall. Compelling and articulate, he would sit at the lectern chain-smoking gold-tipped English Ovals. He would smoke each one down to the very tip and then, without taking a break, light the next cigarette with his last puff. "My wife said she would divorce me if I didn't see a doctor about my cough," he told me as I examined him. "It keeps her up at night and she claims I'm banned from Lincoln Center for drowning out La Sylphide," he said with the same dry wit that charmed generations of students. "Can you give me a cough medicine that really works?" But Professor Harris didn't have just a simple cough and he would need more than cough syrup. I had to tell my intellectual hero that he had chronic obstructive pulmonary disease or COPD. He is far from alone. Over the years there has been a relentless rise in the number of cases of COPD throughout the world. In my practice at Mt. Sinai Medical Center in New York City, over 40 percent of my patients now suffer from this debilitating and frequently fatal disease. It is estimated that COPD affects 35 million Americans, but only half are aware that a lingering cough, chronic bronchitis, and shortness of breath are signs of this serious health problem. On an international level, COPD affects more than 20 million people in Europe, almost 30 million in Latin America, and a staggering 258 million in Asia. The Rise of an Equal Opportunity Killer In the mid-1960s when I was in training at Bellevue Hospital, COPD was seen as a disease of old men. Most of my COPD patients were men in their sixties who had lived and played hard. Heavy drinkers with nicotine-stained fingers, they rattled windows with their coughs, keeping other patients up at night. One day I was on rounds with Dr. John McClement, the grand old man of chest medicine. In the 1920s, tuberculosis was arguably the leading public health problem in large cities in the United States. Director of the chest service at Bellevue, Dr. McClement was one of the people credited for bringing this once fatal and epidemic disease under control in New York City. That particular morning there had been more than the usual number of people with COPD admitted to the floor and there was some confusion about the patients. In their blue-and-white hospital gowns, and with their unshaven faces covered with oxygen masks, the four older men looked almost identical. "Maybe we should just number them," I joked with the insensitivity of a very young doctor. Dr. McClement just nudged me with his elbow. "See those young women at the nursing station?" he asked, pointing to a group of nurses lighting up cigarettes with their morning coffee. "In twenty years, they too will be your patients," he predicted. Unfortunately, he was right. Over the past two decades, I have seen a sharp rise in the number of people affected with COPD. No longer a disease of aged roues, my COPD patients include dancers, ambassadors, writers, teachers, and reporters. Even more troubling has been the startling increase in the number of women with COPD. Figures from The National Center for Health Statistics report that the rate of COPD has risen in women 100 percent since 1992. Watching the Women Dr. McClement's prediction was especially ominous because of the importance that epidemiologists place on disease incidence in women. Epidemiology is the study of patterns of disease. Who they are and where people be