At present, advice for primary prevention is limited to the
admonition: "If you don't smoke, don't start, and if you do, stop as soon
as possible." Detection of emphysema and chronic bronchitis is complicated
by the insidious nature of these diseases.
They may take a long time to produce
symptoms, and by the time they do, much damage has been done. There are certain
clues, however, that make the physician suspicious that a patient may be
showing early signs of chronic bronchitis or emphysema. One is a history of
chronic "cigarette cough," usually worse in the morning on arising
and frequently productive of sputum. Another is a history of frequent respiratoryinfections which are severe and take long to resolve.
There are other possible
clues: on physical examination, the physician may detect some wheezing after
forced expiration or may find an increase in chest diameter ("barrel
chest"). Not everyone with such symptoms and signs necessarily has
emphysema or chronic bronchitis, but the physician may suspect that this is the
likely diagnosis if there is no past history of asthma, other lung or heart
disease, and if there is a smoking history of ten or more years' duration.
By making use of
certain simple lung function tests (spirography), the physician can confirm the
diagnosis. While chest x-rays may not reveal emphysema until the disease is
well along, the routine yearly or semiannual physical checkup is the time for
detection of symptoms and signs that indicate that emphysema may be present
-and with early detection, appropriate measures can be taken to pre- vent
worsening. All too often it is severe shortness of breath or severe respiratoryinfection that brings the emphysema patient to the doctor for the first time-at
a point when much damage may already have been done.
Are chronic
bronchitis and emphysema different diseases? When lung tissue is examined under
the micro- scope, a distinction can be made. But during life, the distinction
is hazy be- cause the two problems so often co- exist. For this reason, they
are frequently described together under the name of "chronic obstructive
lung disease" (COLD) or "chronic obstructive pulmonary emphysema"
(COPE).
The word "obstructive," which appears in both names, refers
to the changes that occur in the air passages (the bronchi and bronchioles)
which conduct air to the lung areas where oxygen is ex- changed for carbon
dioxide. The bronchi and bronchioles serve as a first line of defense against
infection. They have special cells that destroy invading organisms.
