Carson’s death puts spotlight on increase in emphysema

January 25, 2005

Columbus Dispatch (Columbus, OH)

Stop smoking. Now. That’s the public-health message behind Johnny Carson’s death Sunday of emphysema, anti-smoking advocates say. "Almost everybody with emphysema has a history of regular cigarette smoking," said Dr. Philip Diaz, Medical Director of Pulmonary Rehabilitation at Ohio State University.

A heavy smoker for most of his life, Carson died at age 79.

His death promises to raise awareness of a disease that many people dismiss as self-induced.

Calls to the National Emphysema Foundation doubled yesterday, while the American Lung Association of Ohio expected increased traffic on its Web site.

"Whenever somebody of Carson’s stature dies, people naturally are curious about the cause of death," said Larry McAllister, president and chief executive officer of the state association. "A lot of people didn’t know he had emphysema."

Although the rate of smoking among U.S. adults has declined steadily for decades, Diaz said, "The incidence of emphysema actually has been going up."

Emphysema, asthma, chronic bronchitis and a combination of emphysema and bronchitis are defined as chronic obstructive pulmonary disorder, the rate of which has doubled since 1979, according to the American Lung Association.

By 2020, the World Health Organization predicts, the disorder will rank as the third-leading cause of death in the United States.

Diaz attributes the increase to the aging of a population that began smoking in the 1950s and ’60s.

Only 9 percent of the 3.1 million Americans in 2002 who received an emphysema diagnosis were younger than 45; nearly 50 percent were 65 or older.

The destruction of lung tissue that characterizes emphysema results from the cumulative effect of smoking.

Among the group of COPD diseases, "Emphysema is by far the biggest killer," said Kathleen Cowen, senior epidemiologist with the Columbus Health Department.

An analysis of death certificates for 2000 to 2002 identified chronic obstructive pulmonary disease as the No. 4 killer in Franklin County, behind heart disease, cancer and stroke.

Emphysema alone killed more than 10,000 Ohioans from 1990 to 2002, according to the Ohio Department of Health.

Despite a higher death rate historically among men, women are catching up.

Women accounted for nearly 49 percent of the Franklin County deaths from the disorder from 2000 to 2002, compared with 40 percent from 1994 to 1996.

Treatments are intended to slow the progression of the incurable disease or improve the quality of life.

Physicians often prescribe medications to enlarge constricted airways and thus improve breathing. They also recommend exercise to increase strength and endurance.

Many patients require supplemental oxygen, some of them all the time.

In a low percentage of cases, lung surgery — including transplantation — might help.

"But the most important thing we can do," Diaz said, "is to get people to stop smoking as soon as possible."

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