Chet Cooper, Lia Martirosyan and Nancy Villere met up with actress and
activist Loni Anderson who talked about growing up with parents who
smoked; the effects of chronic obstructive pulmonary disease (COPD);
and the difficult challenges that caregivers often face. And an exciting
snowmobile ride down memory lane during Connie Stevens Jackson
Hole Extravaganza with QuintonLoni and Burt Reynolds son.
Chet Cooper: What
are you up to these days
Loni Anderson: November was packed: There was the Great American Smokeout,
and it was also COPD Awareness Month and Caregiver Awareness Appreciation
Cooper: And what happens in December?
Anderson: (laughs) Those issues are still relevant no matter
what time of year it is. Were always making people aware of the
importance of caregivers and reminding them that they need to be appreciated.
We are also spreading awareness of COPD. People hear about it, but they
dont know what it is. COPD is an umbrella term for chronic bronchitis
all the way through end-stage emphysema. So it encompasses many stages
of breathing difficulty. Ninety percent of cases are caused by smoking,
and then theres a small percentage, just a tiny fraction, caused
by a genetic mutation. But also air pollution and second-hand smoke
would be in that last 10 percent.
The reason Im involved of course is because both of my parents
were smokers. My mom started when she was 11, my dad when he was 14.
That was back in the 40s and 50s when cigarette smoking
was considered to be incredibly glamorous. Remember Bette Davis? People
were lighting their cigarettes off one another, and it seemed so romantic
and iconic, before we knew what smoking could do to you. My dad ended
up as a four-pack-a-day smoker, and my mom lit one right after the other.
My dad had developed chronic bronchitis by his late twenties that then
moved into emphysema; he died at 54. My mother thought she had asthma,
but it was really COPD, chronic bronchitis, and then she died just after
turing 60. They were both debilitated over the years since my sister
and I were teenagers. At that time, we didnt even know what it
was. Nobody called it COPD. Everybody said, You have a cough.
Do you want some antibiotics? Nobody really understood what it
was, and what it did to your lungs.
Cooper: Smoke and mirrors.
Anderson: Yes, that is the era we grew up in. We used to laugh about
the fact and say, We dont need an alarm when its time
to get up and go to school, cause Dadll be coughing.
It started out that he would cough maybe 15 minutes to clear his lungs
before he got ready for work, and by the time we were in college it
was an hour. He had to get up an hour early just to clear his lungs
before he could start getting ready.
My mother was kind of a high-strung person. I was the older daughter,
so my dad would confide in me. He didnt want to worry my mom.
He would tell me things that were happening with him. He said, Today,
I was walking down the street and I actually had to lean up against
the building to catch my breath. And I thought, oh, please dont
let me pass out on the street. Somebody will think that Im just
inebriated. He was embarrassed about the cough, because he said
people thought he had an illness that he was going to spread to them,
like That isnt very nice, that he actually came out when
he had a cold and infected the rest of us. So he felt like he
needed to explain it, and he didnt know how to explain it. It
started to curtail all the wonderful things he loved to do.
Cooper: What kind of work did he do?
Anderson: He was a chemist and dealt with chemicals for water treatment.
He was kind of an environmentalist way before his time, testing our
water regularly. There were test tubes in our house. He was very afraid
of what was going to happen to the environment. And yet he smoked constantly.
Your doctor smoked. Everybody smoked. So he would say, I think
Im going to give up the bowling league. And it was out of
embarrassment of being around the other guys, because he was losing
the ability to catch his breath and continue on with his normal activities.
Thats often what people with COPD do; they slowly stop doing things,
not even noticing it. So a caregiver or a loved one starts to see whats
happening to them. Dad doesnt bowl any more. He made
it seem like it was cool to just take the golf cart around the course,
as if walking is so old-fashioned.
Hed made a joke of it. Hed say, You want to be my
driver? And then all the guys would ask, How did you get
that pretty girl to drive you around? And stuff like that. It
was how he dealt with being embarrassed in front of his friends. He
felt like an old man, and he didnt like it. Even after my daughter
was born and came of age, she was his driver on the golf course, but
certainly my mom did panic more about him. She worried more about his
lack of activity. After he died, and her chronic bronchitis, emphysema,
became worse with COPD, Id get these panicked calls from her in
the middle of the night. I cant breathe! I cant breathe!
Cooper: That must have been so hard.
Anderson: Yes. And at that time it wasnt like, Ill
go get the other phone, you stay on the line with me. Back then
you had to hang up, call 911 and get rushed to the hospital. And she
still wasnt even diagnosed. Nobody had a website, nobody had a
computer to go to and get help.
Cooper: Were you in college at the time? Where was she based?
Anderson: My parents lived in Minnesota, and I was there with them.
Then, when she got ill, I was living in LA, and she had moved to Arizona.
Eventually, she moved to LA to be near me, so at least I could keep
an eye on her.
Cooper: She moved to Arizona because of her health?
Anderson: Arizona was where my sister lived, but she was married with
children and had her own health issues at the time. Sometimes it falls
to one family member to be the caregiver. What were talking about
now is that the caregiver cant be afraid or embarrassed to reach
out and ask for help from a friend or relative, somebody else who loves
that person, and say, Just help me for two days or an hour.
I used to go to the basement and have a little freak-out where Id
just cry, because I felt solike I didnt know what to do.
I wanted to help, and I wasnt sure what I was doing. I felt so
sad, then Id come back up, and I was the cheerleader again, because
as a caregiver thats what you are. And then your tendency is to
say, Let me do that for you. Ill take care of it. You just
With our COPDTogether website everybody can go there and get help as
a caregiver. Theres a brochure on the website and a little diary
so you can keep track of your loved one, and learn how theyre
changing in ways that you might not even notice. So when you visit the
doctor, because everybodys nervous about going to the doctor,
you need a second set of ears, and you need a little handwritten diary
where you can see, This is whats happening. Last week this
happened. All the things that the person might forget to say because
theyre so nervous being a patient. If I had had all those tools
at my disposal, I would have found it helpful. And just to have people
to talk to.
Cooper: You said, Let me help you, and now you realize
that you should have encouraged them to help themselves all along?
Anderson: The more you exercise your muscles and your lungs by remaining
active, the more lung power you have. So by just being sedentary, sitting
on the sofa and not doing anything, youre really defeating the
lung capacity you have left. If somebody says, I just cant
wash the dishes, you say, You know what? If you just stood
here maybe and chopped the vegetables, so at least they feel that
theyre still involved. I think that was the worst thing for my
dad, to feel that he was superfluous and didnt have a place in
anybodys life anymore because he couldnt do anything.
Its also important not be too afraid or too embarrassed to take
the medications. Dr. Dennis Doherty has said that with the nebulizer,
puffers, and all those things that help you breathe as the disease is
progressing, you can actually get back some lung capacity and have a
better quality of life. Unfortunately, these things were not available
to my parents.
Cooper: This morning I was in an elevator and this older person was
outside, running up to catch the elevator, and as I let it close, I
said, Take the stairs.
Anderson: You were a bad boy! (laughs) I know you are.
Cooper: But even though it was a joke, theres a bit of truth
there. Let people do some exercise.
Anderson: Have them do a little bit more for themselves, or share an
activity, where the caregiver might say, Lets do this together.
Be supportive, not just say, You go sit on the sofa, and Ill
do this. But also recognize when a disease is getting worse, and
that you have to do something more. Your patient is depressed. The caregiver
gets depressed, because they cant make it better. Its not
a reversible disease, but only slightly. You cant get rid of it.
Its there. But any time you stop smoking, as we know, you stop
the loss of your lung capacity from where you stopped. Even though its
less than somebody who maybe never smoked, your loss of lung capacity
is now progressing at the same rate as you age.
Cooper: Do you have, say, five tips for caring for the caregiver?
Anderson: You have to take care of yourself. My biggest tip is, you
cant take care of somebody else unless you take care of yourself.
Thats where you have to call in a friend or a neighbor or your
sister or your brother or your mom or your dad, whomever is around to
help you, and just say, Can you come and be with our loved one
while I take a break? Go to the movies, go to the spa. Get your
makeup done at Bloomingdales. Whatever helps you to just have
a moment so that you can come back refreshed. You realize with people
who need care, it affects the whole family. You miss days of work. It
just trickles on down, so you do need to call in loved ones to help.
Cooper: Thats one.
Anderson: Wasnt that all of it? Go to the website, get help and
join a group of other caregivers, so that you can all talk about what
youre going through and feel like youre not alone. A lot
of times the caregiver feels like, I cant complain, I cant
say anything, because look at the poor person Im taking care of.
Theyre the one with the illness. But youre also affected
by it, so you might need the support of a group.
Cooper: Thats two. The third isand you do this alreadyexercise.
Anderson: Absolutely. Definitely taking care of yourself. Exercising,
eating right and getting enough sleep. As a caregiver that is so incredibly
important. Heres another wonderful tip: laughter. Laughing expands
your lungs. Its an incredible exercise. A lot of people go to
a funny movie or they go to a support group of other people who have
COPD, and everybody gets a comic in. They watch a funny movie and they
laugh because its an incredible exercise. Keep laughing.
Cooper: Say something funny.
Anderson: (laughs) Any time you laugh you expand your life, because
it releases a lot of wonderful endorphins. If youre depressed,
it also makes you feel better.
Cooper: Thats always the trick. When youre feeling depressed,
how do you get that laughter to come out?
Anderson: Just take a step away from yourself for a minute. Thats
where entertainment is so valuable, I think. You just take a moment.
We all know that if you go to a movie, for just those two hours, youre
not in your life. Youre in the world of the movie. So taking your
mind off your difficulties is so good.
Cooper: Nancy and I carpooled. I said, Nancy, Im feeling
a little depressed. She turns on her radio and its programmed
to the comedy station. She keeps
Anderson: So youre already doing it.
Nancy: Yes, every time Im in the car I listen to comedy stations
on Sirius radio.
Anderson: Its so healthy. Shes going to live a long time.
(laughter) And, of course, I married a really funny person. When I met
my husband, I said, Hes better than TV.
Cooper: But hes harder to turn off.
Anderson: (laughs) You have to surround yourself with cheerful
people. The other thing is smiling. A lot of times when were depressed,
if you just smile, somebody will usually smile back at you, and that
just helps you feel better.
Cooper: Lias signature on her email is Music & Laughter.
Anderson: Music. All of those things that are joyous to you. (laughs)
Cooper: Yes, sing.
Lia Martirosyan: So a nun, a frog and a priest walk into a bar
Cooper: Are you doing a tour to get the message out?
Anderson: Weve just begun this whole campaign with Sunovion Pharmaceuticals,
because we wanted to raise awareness and get the message out. We have
to appreciate our caregivers. And COPD is the only one of the top five
killer diseases thats growing. Everything else is going down.
Although theres still a huge population of smokers.
Cooper: Are we talking about global numbers or US numbers?
Anderson: Were talking about the US.
Cooper: I can understand global, because the tobacco companies pushed
real hard to market outside the States, where there are fewer restrictions.
Anderson: But even US numbers. And women are more susceptible, because
their lungs are smaller, and theres something different in our
genetic makeup. So COPD is rising more in women. Before it used to be
thought of as just a mans disease.
Cooper: Didnt men smoke more than woman at one time?
Anderson: Yes. And then, we all got liberated in the 60s and one
of the things we did was start to smoke.
Cooper: And burn your bras! That was a smoke joke, burning.
Anderson: Smoke your bra.
Cooper: On a personal note, have you done any more snowmobiling?
Anderson: I actually have done a lot since I last saw you.
Cooper: OK, then Im mad at you. We were supposed to go together.
Anderson: We were supposed to go together, but my daughter was living
in Mount Shasta, and so at Christmastime we would go snowmobiling. Now
theyve moved to Redding, so we have to drive all the way to Mount
Shasta, which isnt too bad, to do our snowmobiling. And I have
yet to take my husband.
Cooper: We need to get together and do this....
in ABILITY Magazine
I recently visited a friend in her high-rise office in New York City. She asked me to take a walk and then led me up a flight of stairs to the roof to show me the view of the Hudson River. One part of the roof had been taken over by smokers who, prohibited from lighting up inside, congregated atop the building to nurse their addictions. As we looked toward the river, I turned to see a couple of people finishing the flight of stairs to come to the roof to smoke. Both were winded and coughing but couldn’t wait to catch their breath before lighting up. My friend asked me, “Why do people cough and get out of shape from smoking?” I said they probably had the beginning stages of COPD. Of course, she then asked, “What is that?”
Chronic obstructive pulmonary disease (COPD) is caused almost exclusively by one factor—smoking. Tar and other corrosive chemicals damage the airways and small air sacs of the lungs, making it increasingly hard to get air in and out and to absorb oxygen into the body. Affecting an estimated 16 million Americans, COPD is the fourth leading cause of death in the U.S. However, because it develops slowly—COPD is diagnosed most frequently in middle-aged or older people—lung changes are often underway for many years before people notice symptoms like shortness of breath. While there is no cure for COPD, stopping smoking dramatically slows its progression, and medical treatments and lifestyle changes can reduce some of the symptoms.
What Is COPD?
The lung’s airways branch out like an upside-down tree. At the end of each branch are many small, balloon-like air sacs called alveoli. In healthy people, the airways are clear and open, the alveoli are small and dainty, and all components are elastic and springy. With each breath in, the alveoli fill up with air like small balloons, and with each breath out, the balloons deflate and the air goes out. In COPD, however, the airways become swollen and the air sacs become deformed and eroded.
COPD includes two main components, chronic bronchitis, which is present in virtually all patients and is partially reversible, and emphysema, which is present in some and is irreversible.
In chronic bronchitis, the airways leading into the lungs become inflamed and thickened and the cells lining them produce excessive amounts of mucus. These changes cause a chronic cough and difficulty getting air into and out of the lungs. They also destroy specialized cells in the airways that help sweep bacteria and irritants out of the lungs. As a consequence, people with chronic bronchitis have a higher risk of lung infections.
In emphysema, the walls between many of the alveoli are destroyed, leading to a few large air sacs instead of many tiny ones. These changes dramatically reduce the lungs’ capacity to absorb oxygen and get rid of carbon dioxide. The lungs rely upon the vast surface area created by millions of alveoli to allow oxygen to enter the blood stream through tiny blood vessels in the alveoli walls. When the walls collapse, the larger air sacs that remain do not have enough surface area to absorb all the oxygen the body needs. Additionally, the walls of some of these larger air sacs become stiff and can no longer push air out of the lungs when the person exhales. Air becomes trapped in the resulting dead space, and these parts of the lung are, in effect, removed from functioning. As the lung becomes more scarred and oxygen levels fall lower, people become susceptible to severe complications like respiratory failure and heart failure.
By the time most smokers begin to notice the symptoms of COPD—like chronic cough or shortness of breath when working hard or walking fast—they have progressed already to a moderate stage of the disease. In severe COPD, people have trouble breathing after just a little activity, such as doing household chores, unloading groceries, bathing and dressing. At this stage, quality of life is greatly compromised and the worsening symptoms can be life threatening.
What Factors Influence COPD?
Almost all cases of COPD develop after people repeatedly breathe in fumes that irritate and damage the lungs and airways. Smoking (including cigarette, pipe and cigar smoking) is by far the most common cause, responsible for 85 to 90 percent of all cases. While only 15 to 20 percent of smokers are formally diagnosed with COPD, this commonly cited statistic is now known to be a gross underestimate of the number of people affected. Some recent data suggest that 70 to 90 percent of smokers develop COPD during their lifetimes, and 20 percent develop it rapidly. Occupational exposure over prolonged periods to dust, certain chemical fumes and gases can also contribute in some cases.
There is controversy over the role that exposure to heavy air pollution and second-hand smoke plays in COPD. Several studies show that these factors worsen other respiratory illnesses such as asthma, increase the risk for symptoms such as wheezing and coughing, and make the airways more sensitive to irritants. Nevertheless, current studies have yet to conclusively link them to the more severe changes of COPD. For example, one of the largest studies to date of second-hand smoke showed no increase for spouses of smokers in deaths from COPD, heart disease or lung cancer—the three most significant killers of smokers—as long as the spouses had never smoked themselves.
It remains largely unclear why some smokers develop COPD and others do not, but some evidence points to the role of genetics. Smokers whose parents had COPD are more likely to develop COPD themselves. In rare cases, COPD is caused by genetics even when smoking is not involved: Alpha 1 antitrypsin deficiency, or familial emphysema, is caused by the hereditary deficiency of a protein needed to inactivate destructive enzymes in the blood. This imbalance leads to the destruction of the lung and COPD. If people with this condition smoke, the disease progresses more rapidly.
How is COPD Diagnosed?
COPD is often misdiagnosed as a respiratory infection or asthma because symptoms can be similar, although the distinction can be made with a careful history, physical exam and breathing tests. Doctors should consider a diagnosis of COPD when a patient has the typical symptoms and a history of exposure to lung irritants, especially cigarette smoke.
A quick, painless breathing test called spirometry can detect COPD long before a person has significant symptoms. Patients breathe hard into a large hose connected to a machine called a spirometer, which measures how much air their lungs can hold and how fast they can blow the air out after taking a deep breath. Additional tests may be performed to help determine the stage of COPD and to evaluate for other illnesses, such as heart failure, that can cause shortness of breath.
How is COPD Treated?
Quitting smoking is the single most important thing a person can do to reduce the risk of developing COPD and to prevent it from becoming worse.
Medical interventions for COPD can help relieve some of the symptoms, but COPD cannot be cured. The goals of treatment are to improve breathing, slow the progression of the disease, increase the ability to stay active, prevent and treat complications and improve overall health. Depending on the severity of illness, some patients may be referred to a lung specialist called a
The primary COPD medications, called bronchodilators, work by relaxing the muscles around the airways so they open more quickly and breathing is easier. Most bronchodilator medications are inhaled. Because there are many kinds of inhalers, it is important for patients to know how to use theirs correctly, and they should ask the doctor or pharmacist to observe them administering a dose. Other medications sometimes used include corticosteroids, which reduce airway inflammation, and mucolytics, which break down mucus and make it easier to clear from the lungs.
Because lung function is already reduced in people with COPD, infections like influenza or pneumonia can be devastating. Therefore, yearly flu vaccinations and the one-time vaccination against pneumococcal pneumonia are very important.
Another mainstay of COPD treatment is pulmonary rehabilitation, where many different health care professionals work together to help people with COPD stay more active and have less difficulty carrying out their day-to-day activities. Programs include exercise, education in disease management, breathing retraining, nutritional counseling and psychosocial support. Respiratory therapists teach pursed-lip breathing, which helps relieve some of the fatigue people with COPD develop from breathing rapidly and shallowly. Occupational therapists teach ways of doing daily activities so as to conserve energy and lessen exertion.
For people with severe COPD and very low levels of oxygen in the blood, doctors may recommend oxygen therapy. In these cases, using extra oxygen can help people do activities with less shortness of breath, help protect the heart and other organs from damage and even prolong life.
In a small number of cases, surgery may be recommended for people who have severe symptoms, have never gotten improvement from medications and have a very hard time breathing most of the time. Surgery may remove an unusually large air sac that compresses healthy lung tissue, or it may involve complete lung transplant.
How Does One Stop Smoking?
COPD has been thought of as a disease of the elderly, but in recent decades the decline in the average age at which people begin smoking (now age 10) means that someone who smokes a pack a day could reach, by age 30, the average exposure sufficient to produce symptomatic COPD. When the toll from COPD is added to the toll from other illnesses caused by smoking—such as heart disease, stroke and cancer—tobacco-related illnesses account for 20 percent of all deaths in the U.S. That means that the single most important step a person can take to maintain health and prolong life is to stop smoking.
Nicotine withdrawal symptoms such as depression, insomnia, irritability, anxiety and poor concentration are the main deterrents to quitting for most people. Studies show that more than 60 percent of people who smoke report that they intend to quit within the next 6 months, yet each year only 3 to 5 percent of those who attempt to stop will achieve a sustained quit (greater than 12 months). It is estimated that people who smoke need an average of four attempts to quit before they are able to maintain sustained cessation.
Chances for quitting successfully can be improved with the use of medications and behavioral therapy. The standard approach to drug therapy for smoking cessation has been nicotine replacement systems—including patches, gum, inhalers and nasal sprays—which help smokers withdraw gradually from nicotine. While some people avoid nicotine replacement because they don’t see the advantage of switching to another product that is still addictive, it is important to recognize that nicotine replacement is infinitely safer than smoking. While nicotine is the substance responsible for the addiction, tar and many other chemicals in tobacco cause the lung damage and other health problems. Using nicotine replacement is estimated to double a smoker’s chances of quitting successfully. The antidepressant buproprion (marketed as Zyban or Wellbutrin) has also been shown to reduce withdrawal symptoms and can be used alone or in combination with nicotine replacement.
Medications work far better when combined with behavioral therapy, although few smokers take advantage of the available programs. Behavioral therapy helps people identify barriers to quitting and plan to prevent relapses. An average of 20 percent of people who participate in a behavioral therapy program are able to maintain sustained cessation, a significantly greater success rate than in smokers who try to quit without support.
It is difficult to stop smoking, but it can be done. For those folks smoking on the rooftop who want to quit, I hope you keep trying.
by Gillian Friedman, MD
American Lung Association
National Heart, Lung, and Blood Institute
The Foundation for a Smoke-Free America
National Cancer Institute’s Smoking Quitline
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