My dad who was a chain smoker died of emphysema when he was 63, so I know what this article says is true. I never took up smoking because of what I saw my dad go through. Emphysema Is A Stealthy Killer of Smokers By Shari Rudavsky firstname.lastname@example.org January 28, 2005 To understand the experience of people with emphysema -- the disease that earlier this week killed Johnny Carson -- put a hollow plastic coffee stirrer in your mouth, hold your nose and try to suck in air through that tiny straw. Now, imagine that you feel this way with each breath you take. "This is a nasty disease; it's one of the worst kinds of deaths and diseases to experience, because you can't breathe," says Karla Sneegas, executive director of Indiana Tobacco Prevention and Cessation, a state agency that educates the public about the health risks of tobacco use. While lung cancer gets much more attention, chronic obstructive pulmonary disease (COPD) -- a collection of maladies including emphysema and chronic bronchitis -- is far more common. COPD affects as many as 21.7 million Americans, many of whom do not know they have the disease, which is the fourth leading cause of death. In Indiana, which has the nation's sixth highest smoking rate, COPD is a major killer, claiming more than 3,100 lives a year. And, frustratingly enough for doctors, emphysema -- a condition in which the air sacs of the lung degrade, causing the lung to lose its elasticity -- can be prevented or halted in its early stages. "In Johnny Carson's case, if he would have come to see me 20 years ago, we would have interceded, gotten him to stop smoking, get him on some medicines," says Dr. Michael Busk, a pulmonologist at Indiana University School of Medicine. "Early intervention is a key, but people don't come in until it's too late." The simplest way for most people to avoid emphysema altogether: Don't smoke. For those who already smoke, the answer is to quit as soon as possible. Smoking accounts for between 80 and 90 percent of all cases of COPD. Studies show that people who quit smoking do not continue to lose lung function. Those who don't quit continue to damage their lungs. While doctors may urge their patients to quit, they also share some of the burden for early detection of the disease, Busk says. Too few primary-care physicians test the lung functions of their patients who smoke. A relatively simple test with a machine called a spirometer can identify those in the beginning stages of the disease, opening the door for intervention. Patients often have no clue until it's too late that their lungs are under attack from the cigarettes they're smoking. Most cases are diagnosed only after years of smoking. More than 91 percent of the 3.1 million Americans diagnosed with emphysema are older than 45, according to the American Lung Association. "Emphysema is usually a process that takes years to develop. It's very insidious because as your lung is destroyed, your body figures out a way to adapt. You don't really realize it until it's too late," says Dr. Stephen J. Jay, a pulmonologist and chair of the department of public health at IU's medical school. "Then, tragically, once destruction occurs in your lung with emphysema, it's largely irreversible." Doctors can treat the symptoms, such as shortness of breath or a persistent cough, with medications like steroids. Many with emphysema go on oxygen to ease the shortness of breath. As COPD progresses, it can lead to heart failure or pneumonia. But there's no way to turn back the clock on years of smoking. "What I tell my patients is, if you smoke cigarettes, there will be damage. The lungs do not repair themselves, and you do not get new lungs," says Busk, chairman of the Indiana Thoracic Society, part of the American Lung Association of Indiana.