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Non-smoker, 74, has emphysema

Dear doctors: I am 74 years old and recently was hospitalized with pneumonia. While there, I had X-rays and CT scans. I have never smoked, but I have been exposed to a lot of second-hand smoke. I have been diagnosed with asthma and emphysema.

Dear doctors: I am 74 years old and recently was hospitalized with pneumonia. While there, I had X-rays and CT scans. I have never smoked, but I have been exposed to a lot of second-hand smoke. I have been diagnosed with asthma and emphysema. I would appreciate knowing the treatment for this, as they say there is no cure.

J.H.

The lungs are the body's breathing apparatus and they consist of tiny air sacs, called alveoli, the place where oxygen and carbon dioxide are exchanged. Emphysema is a disease that destroys the connective tissue in the lung, leading to loss of these alveoli. Fewer alveoli, less oxygen exchange.

In industrial countries, emphysema is almost always caused by smoking tobacco, and it's a progressive process - with continued smoke exposure, there is further loss of lung tissue.

The airway obstruction in emphysema is due to the destruction of the connective tissue, which causes the airways to collapse. Asthma also causes obstruction, but it's generated by constriction of smooth muscle inside airways. The obstruction by asthma is reversible with relaxation of the muscle fibres, and also by reducing the inflammation inside the lungs.

Your smoke exposure came from somebody else's tobacco, and it is important to note that second-hand smoke is a major cause of disease: lung disease (both asthma and emphysema), heart disease and cancer.

The first step in treatment is to stop the smoke exposure. For a smoker, that means quitting, but for people like you, exposed to second-hand smoke, that means the person exposing you to smoke can't smoke near you or where you live or work.

That is not always easy, but the sooner you do that, the sooner the damage to your lung will stop. Still, some people aren't diagnosed until after they have already quit (or the person exposing them has).

There are numerous medications to help the symptoms of asthma and emphysema: Many medicines work for both conditions.

Some are inhaled, like albuterol, which relaxes smooth muscle in airways, and corticosteroids, which reduce inflammation. Others, like Singulair, which also reduces inflammation, are taken by mouth.

Emphysema and asthma are both usually treated by an internist or a pulmonologist, a specialist in lung problems.

Dear doctors: I am told the vaccination for whooping cough actually causes the disease whooping cough. What is your opinion on this?

R.L.

The current pertussis vaccine does not contain any cells, so there is no possibility of contracting pertussis through the vaccination.

Unfortunately, misinformation tends to spread far and wide. Some parents even worry that vaccination can cause childhood diseases like autism, but the consensus from well-done studies has been unequivocal that these vaccines are not the cause. They do prevent hospitalization and death.

Not giving the pertussis vaccine (currently recommended as part of a combination with tetanus and diphtheria, called DTaP or Tdap) has led to epidemics of unnecessary illness, hospitalization and much time off work and school. Vaccinating healthy adults reduces the risk for infants.

It's especially important for pregnant women, since protection is transmitted to the baby first through the placenta, then through breast milk.

Dear doctors: I had a kidney stone years ago, but none since. I drink lots of water. I buy it in the supermarket and only buy distilled water, water without minerals. I was never told the composition of my kidney stone. I do drink other water when it is served to me.

G.G.

You're right on the mark. The best way to prevent a recurrence of kidney stones is to keep well-hydrated. That means taking in two to 2 1 /2 litres of fluid a day. Water is excellent. You don't really need distilled water. If you like it, stick with it. And all that fluid can be any liquid, even coffee and tea.

It's also a good idea to reduce salt intake. Salt encourages the passage of calcium into the urine. The most common kinds of kidney stones are calcium phosphate and calcium oxalate.

Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors at P.O. Box 536475, Orlando, FL 32853-6475.