Smoke Signals

Chronic Obstructive Pulmonary Disease hits Tennessee hard.

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The Legalities of Prevention

After talking for 20 minutes, Helen Cleaves is exhausted, short of breath. But you can hear the frustration in her voice when she describes a recent visit to the hospital: “All they could do when I came to the hospital is just make me comfortable,” she says. “Nothing else.”

Exercise, smoking cessation, medication to ease the symptoms — these are the treatments for COPD. There is no cure.

That’s why when Memphis physicians talk about fighting COPD, they talk about prevention — in particular, the battle against smoking.

In 2007, Tennessee cracked down on secondhand smoke in workplaces. There are still loopholes: bars and restaurants whose clientele are over 21 can allow smoking, along with any workplace with four or fewer employees.  

The long-term impacts of secondhand smoke can be difficult to measure, but its detrimental impacts have been proven, UT’s Johnson says.

“You can actually measure nicotine levels in my blood if I’m breathing your cigarette smoke in,” she says.

Sheila Harrell at the Church Health Center says that the smoking ban has made quitting a little easier for some people in her smoking cessation class, called Commit to Quit.

“For some people, actually, it helps them think about quitting because it’s just such a taboo,” she says.

But the 2007 law stops short of banning smoking in outdoor public spaces, and Dr. John David Williamson of Memphis says regulating smoking in such spaces may be the next step.

A fine balance must be achieved to maintain personal freedoms, Williamson warns, but “I do think there are public areas that should be more protected.”


Lower Income, Higher Risk

A big part of treating COPD effectively is stopping the disease before it progresses — and among Memphis’ lower-income populations, that’s not always easy.

“Because of the socioeconomic background of Memphis we have a large population who are in poverty and don’t get access to medical care,” Headley explains. That means that people only go to the doctor when the disease is farther along — the worst possible scenario for a disease that’s irreversible.

Williamson is resident director for the family medicine residency program at Christ Community Health Services, which has six medical centers around Memphis. Eighty-four percent of CCHS patients live at or below the poverty line. Even when patients do come in for treatment, getting a spirometry test to confirm the presence of COPD requires visiting another facility — an extra investment of time and money that many patients just can’t afford.

“For our patients it’s all about dollars,” Williamson says. “There are lots of socioeconomic barriers to getting that testing.”

And because lower-income populations tend to have higher smoking rates, the result, Williamson adds, is that “our population that has the highest risk of COPD are the very populations that have the most problems with access to primary care.”

Williamson recommends that anyone trying to quit smoking should pair up with a healthcare professional to guide them. But community health centers like CCHS are often booked to capacity, so that scheduling an appointment can be difficult. Someone with health insurance could simply try another doctor. For the 40 percent of CCHS’ patients who are uninsured, however, that’s just not an option.


The Science of Quitting

Quitting isn’t just about access to the right resources — it’s about overcoming the allure of a powerful drug, day in and day out.

“Nicotine in cigarettes is very addictive. It may be as addictive as cocaine. It’s certainly more addictive than alcohol,” Johnson says.

It’s important to recognize the practicalities of nicotine addiction if you’re going to help smokers quit, and that’s the focus of her research at the University of Tennessee.

At UTCHS, Johnson is about nine months into a National Institutes of Health-funded study called TARGIT, testing an iPod Touch app that provides the same behavioral support for quitting as in-person therapies. The app helps users set a quit date, plan how to deal with urges, and find resources for smoking cessation.

An app similar to that being used in the study, called Quit Forever, is already available on iTunes.

Such an app could be particularly helpful in Memphis, where Harrell says education and support about smoking cessation are sometimes hard to come by. But swapping stories with other people who are trying to quit is also a strong motivator.

“There’s a lot of resources online, but actually being able to come to a class and say out loud, ‘I’m quitting,’ or ‘I’m going to quit next Tuesday’ — it puts the pressure on,” she explains.


Struggle and Hope

Patients are affected very differently by COPD depending on how soon — or how late — the disease was caught, and whether the patient changed his or her behaviors. The difficult truth, however, is that lung function that is lost is never recovered. For Helen Cleaves, a grandmother of 12, the impact has been difficult to bear.

“I used to be so vibrant. I used to do all the running for the family, pay the bills, babysit, all that type of stuff. I can’t do it anymore,” she says.

But Johnson insists that no COPD patient is past hope for a better life.

“At any point in your lung function, if you stop smoking, it will slow your rate of decline,” Johnson says, “so even if you have COPD, it’s not too late to stop.”

The key to success, as it turns out, comes down to that old adage: If at first you don’t succeed, try, try again.

“If you have a slip or if you have a slight relapse, don’t be discouraged,” Johnson says. “Start over, because the more times you try to quit, the more likely you are to quit.” 


Erin L. McCoy, a Louisville native, is a Seattle-based freelancer specializing in science, education, travel, and environmental journalism. Read more of her work at or follow her on Twitter @erinlmccoy.

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