Recently, ABILITY’s 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 Quinton—Loni 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 Month.

Cooper: And what happens in December?

Anderson: (laughs) Those issues are still relevant no matter what time of year it is. We’re 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 don’t 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 there’s 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 I’m 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 didn’t 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 don’t need an alarm when it’s time to get up and go to school, ’cause Dad’ll 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 didn’t 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 don’t let me pass out on the street. Somebody will think that I’m 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 isn’t 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 didn’t 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 I’m 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. That’s 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 what’s happening to them. “Dad doesn’t 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.”

He’d made a joke of it. He’d 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 didn’t 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, I’d get these panicked calls from her in the middle of the night. “I can’t breathe! I can’t breathe!”

Cooper: That must have been so hard.

Anderson: Yes. And at that time it wasn’t like, “I’ll 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 wasn’t 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 we’re talking about now is that the caregiver can’t 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 I’d just cry, because I felt so—like I didn’t know what to do. I wanted to help, and I wasn’t sure what I was doing. I felt so sad, then I’d come back up, and I was the cheerleader again, because as a caregiver that’s what you are. And then your tendency is to say, “Let me do that for you. I’ll take care of it. You just sit down.”

With our COPDTogether website everybody can go there and get help as a caregiver. There’s a brochure on the website and a little diary so you can keep track of your loved one, and learn how they’re changing in ways that you might not even notice. So when you visit the doctor, because everybody’s 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 what’s happening. Last week this happened.” All the things that the person might forget to say because they’re 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, you’re really defeating the lung capacity you have left. If somebody says, “I just can’t wash the dishes,” you say, “You know what? If you just stood here maybe and chopped the vegetables,” so at least they feel that they’re still involved. I think that was the worst thing for my dad, to feel that he was superfluous and didn’t have a place in anybody’s life anymore because he couldn’t do anything.

It’s 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.”

(laughter)

I’m kidding.

Anderson: You were a bad boy! (laughs) I know you are.

Cooper: But even though it was a joke, there’s 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, “Let’s do this together.” Be supportive, not just say, “You go sit on the sofa, and I’ll 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 can’t make it better. It’s not a reversible disease, but only slightly. You can’t get rid of it. It’s there. But any time you stop smoking, as we know, you stop the loss of your lung capacity from where you stopped. Even though it’s 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 can’t take care of somebody else unless you take care of yourself. That’s 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 Bloomingdale’s. 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: That’s one.

(laughter)

Anderson: Wasn’t 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 you’re going through and feel like you’re not alone. A lot of times the caregiver feels like, “I can’t complain, I can’t say anything, because look at the poor person I’m taking care of. They’re the one with the illness.” But you’re also affected by it, so you might need the support of a group.

Cooper: That’s two. The third is—and you do this already—exercise.

Anderson: Absolutely. Definitely taking care of yourself. Exercising, eating right and getting enough sleep. As a caregiver that is so incredibly important. Here’s another wonderful tip: laughter. Laughing expands your lungs. It’s 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 it’s 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 you’re depressed, it also makes you feel better.

Cooper: That’s always the trick. When you’re feeling depressed, how do you get that laughter to come out?

Anderson: Just take a step away from yourself for a minute. That’s 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, you’re not in your life. You’re in the world of the movie. So taking your mind off your difficulties is so good.

Cooper: Nancy and I carpooled. I said, “Nancy, I’m feeling a little depressed.” She turns on her radio and it’s programmed to the comedy station. She keeps—

Anderson: So you’re already doing it.

Nancy: Yes, every time I’m in the car I listen to comedy stations on Sirius radio.

Anderson: It’s so healthy. She’s going to live a long time. (laughter) And, of course, I married a really funny person. When I met my husband, I said, “He’s better than TV.”

Cooper: But he’s harder to turn off.

Anderson: (laughs) You have to surround yourself with cheerful people. The other thing is smiling. A lot of times when we’re depressed, if you just smile, somebody will usually smile back at you, and that just helps you feel better.

Cooper: Lia’s signature on her email is “Music & Laughter.”

Anderson: Music. All of those things that are joyous to you. (laughs) So sing!

Cooper: Yes, sing.

Lia Martirosyan: So a nun, a frog and a priest walk into a bar…

(laughter)

Cooper: Are you doing a tour to get the message out?

Anderson: We’ve 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 that’s growing. Everything else is going down. Although there’s still a huge population of smokers.

Cooper: Are we talking about global numbers or US numbers?

Anderson: We’re 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 there’s something different in our genetic makeup. So COPD is rising more in women. Before it used to be thought of as just a man’s disease.

Cooper: Didn’t 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.

(laughter)

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 I’m 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 they’ve moved to Redding, so we have to drive all the way to Mount Shasta, which isn’t too bad, to do our snowmobiling. And I have yet to take my husband.

Cooper: We need to get together and do this.... continued 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
pulmonologist.

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
lungusa.org

National Heart, Lung, and Blood Institute
nhlbi.nih.gov

The Foundation for a Smoke-Free America
anti-smoking.org

National Cancer Institute’s Smoking Quitline
877.44U.QUIT

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