Smoke Signals

Chronic Obstructive Pulmonary Disease hits Tennessee hard.

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One cigarette a day — after 45 years of smoking, that’s all Helen Cleaves allows herself anymore. But it took a steep decline in her health to get the lifelong Shelby County resident this close to quitting.

“It’s in my head,” she says of nicotine — describing the effect of what physicians know to be one of the most addictive substances on the planet.

Seven years ago, Cleaves started feeling short of breath, and soon enough she was diagnosed with a disease she had never even heard of: COPD.

COPD, or chronic obstructive pulmonary disease, is the third-leading cause of death in the U.S. — yet more than one in three Americans have never heard of COPD.

And it’s hitting Tennesseans particularly hard. A study released in November 2012 by the Centers for Disease Control and Prevention found that Tennessee had the third-highest COPD rate in the country, with 8.7 percent of Tennesseans reporting that they had been diagnosed with the disease.  That’s compared to 6.3 percent nationwide.

What’s worse, the number of people suffering from COPD could be even higher.

“The exact prevalence of the disease is not known, because not everybody is screened for COPD,” explains Dr. A. Stacey Headley, a pulmonologist, University of Tennessee associate professor of medicine, and co-director of the medical ICU at Methodist University Hospital in Memphis.

COPD is the name for a group of lung diseases in which the lungs’ air sacs or airways become inflamed or clogged with mucus, and eventually lose their elasticity or suffer irreversible damage. It’s also linked with higher rates of heart disease, diabetes, hypertension, lung cancer, and bone disease. Chronic bronchitis or emphysema are common manifestations of COPD.

Cleaves’ mother had emphysema and was on oxygen therapy before she died at age 81. Today, at age 57, Cleaves is on oxygen, too.

“I used to ask her why she’d be breathing that way,” Cleaves remembers. “I understand everything now: trying to breathe. Trying to breathe.”

These days, Cleaves is barely able to get out of bed. Even walking to answer her front door can leave her gasping for breath.

“It’s an awful way to live. I depend on somebody to do everything for me,” she says. “I was born January the 19th, 1956, and they’ve given me two years to live.”


Tennessee on Fire

If you smoke, you’re at risk for COPD — period.

“Probably 95 to 99 percent of COPD is from cigarette smoking,” says Dr. Karen C. Johnson, interim chair of the Department of Preventive Medicine at the University of Tennessee Health Science Center.

In Tennessee, 23 percent of adults smoke, compared to 19.3 percent nationwide. The consequences of this are already clear: Tennessee’s smoking-related mortality rate is sixth-highest in the country (behind only Kentucky, West Virginia, Nevada, Mississippi, and Oklahoma) according to the CDC. And we see few signs of improvement: While smoking rates declined 15 percent nationwide between 1996 and 2007, Tennessee’s smoking rate held steady — and the percentage of deaths attributed to chronic lower respiratory diseases increased.

Around 300 people in Shelby County die every year of chronic lower respiratory diseases such as those commonly associated with COPD — and this number doesn’t include those whose COPD led to heart disease or other conditions.

But Shelby County is better off than most. It ranks 72nd out of the state’s 95 counties for deaths from lower respiratory diseases. Macon County, at No. 1, has a mortality rate more than four times higher than Shelby County’s.

Helen Cleaves grew up in Shelby County, along U.S. 64, with two parents who smoked. By age 12, her friends were smoking cigarettes and so was she.

Today, 21.6 percent of young people in Tennessee smoke, and Sheila Harrell, who runs a smoking cessation class at the Church Health Center in Memphis, says this is partly due to a culture that encourages smoking — or at least, doesn’t discourage it.

“Just from the stories that people have told me, they started sneaking cigarettes from their parents or grandparents,” explains Harrell. “I’ve actually heard people say, ‘My aunt would have me light her cigarette and take it to her.’ And they always hated smoking, hated smoking, hated smoking, but at some point in time they turned to it.”


Something in the Air

Smoking isn’t the only culprit. Air pollution is another big contributor to COPD. In fact, on a worldwide scale, exposure to wood smoke is the number-one cause of COPD. This is one reason parts of rural Appalachia, where wood stoves are more commonly used for heating and cooking, have such high COPD rates.

For those who already have COPD, Headley says air pollution can lead to “exacerbations” —  incidents when an individual’s lung function is so poor he or she may need to be hospitalized.

And when it comes to air pollution, Tennessee lies at the southern border of the nation’s largest hotspot for PM2.5 — a particularly harmful type of tiny airborne particle. Wind patterns push polluted air from areas as far as the Northeastern U.S. to gather in the Midwest.

The CDC found that states along the Ohio and lower Mississippi Rivers have the highest rates of COPD. Many of these have some of the country’s highest smoking rates — but many are also in this cloud of PM2.5.
Occupations that involve high exposure to dust or particles, including farming, coal mining, and some manufacturing jobs, can also put people at risk for COPD.


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