By Raanan Geberer
Brooklyn Daily Eagle
BROOKLYN – “COPD [Chronic Obstructive Pulmonary Disease] is a disease that comes on much later in life [than the initial cause]. I have a lot of patients who are shocked when I tell them they have emphysema — they say, ‘I quit smoking 20 years ago.’”
Dr. Sonali Sethi, director of interventional pulmonary medicine at New York Methodist Hospital, was talking about COPD, an umbrella term which includes emphesyma, chronic bronchitis and several other diseases (but not asthma).
While COPD deaths have declined in Brooklyn, the disease remains a major problem — and smoking remains the major cause. Symptoms develop slowly, then worsen over time.
“In Brooklyn, like in the rest of the country, chronic obstructive pulmonary disease is a major source of illness, mortality and disability. At the present time, COPD is now the third leading cause of death in the U.S.,” says Dr. Peter Smith, chief of pulmonary medicine and co-director of the thoracic center at University Hospital of Brooklyn at Long Island College Hospital (LICH).
The problem has been addressed in a new report, “Brooklyn Community Health Report on Chronic Obstructive Pulmonary Disease,” issued by SUNY Downstate Medical Center, LICH’s parent body.
Some of the report’s key findings were hopeful. For example, the percentage of COPD deaths in Brooklyn and the rest of New York City is lower than in the rest of the United States. From 1993 to 2007, emphysema deaths in Brooklyn declined by nearly 150 percent.
However, at the same time, hospitalizations for chronic bronchitis increased 42 percent from 1995 to 2005. And while the emphysema hospitalizations for white Brooklyn residents fell from 66 percent in 1995 to 43 percent in 2005, the percentage of emphysema hospitalizations for black residents rose from 18 to 38 percent during the same period.
The SUNY Downstate report also breaks figures down by neighborhood. From 1995 to 2005, COPD hospitalization rates for Brooklyn residents over 45, who make up the great majority of patients, decreased in every neighborhood except Flatbush. Still, five Brooklyn neighborhoods — Bedford-Stuyvesant, Bensonhurst-Bay Ridge, Downtown-Heights, Coney Island-Sheepshead Bay and Williamsburg-Bushwick — had higher COPD hospitalization rates than the rest of the city.
When one focuses on emphysema in particular, hospitalization rates from 1995 to 2005 declined not only in every Brooklyn neighborhood, but in the rest of the city and state. “This may be explained by the decline in smoking, and possibly by better access to primary or outpatient care for individuals with emphysema,” says the report.
The situation for chronic bronchitis, though, was the reverse of that for emphysema — hospitalization rates for the disease rose in every single Brooklyn neighborhood between 1995 and 2005. The percentages of patients by ethnic group changed during those years, but not markedly.
Dr. Smith says that doctors are also seeing more COPD among women. All in all, he says, the typical COPD patient is someone in his or her 60s or older. That means when that particular patient started smoking, 40 or more years ago, anti-smoking efforts among health and government agencies were still fairly recent and smoking was still widespread.
While years of anti-smoking efforts and laws, plus the high cost of cigarettes due to taxation, have caused smoking rates to go down, says Dr. Smith, this “doesn’t match up against the tobacco industry’s much greater effect on promoting smoking. Now they’re restricted in marketing to some extent, but whatever they don’t sell here, they sell abroad.”
Dr. Sethi concurs: “I think we [in New York] are very sensitive to smoking cessation. We’ve stopped smokers in bars and restaurants, but we’re oblivious about what’s going on in the rest of the world. Recently I went into a restaurant [somewhere else in the U.S.], someone lit up a cigarette, and I almost fell out of my chair.”