DEAR DR. ROACH: I am a 46-year-old man, nonsmoker, who has worked in factories on and off for 25 years. I am on Advair and Proair for emphysema. I also take metoprolol for high blood pressure. My dad’s second cousin passed away from emphysema. My liver and heart appear good.

At my age, is it more likely that I have hereditary low alpha-1 antitrypsin, or did I get my emphysema from working in factories? What should I eat? Can I exercise my lungs to help me breathe easier? — J

ANSWER: Emphysema is a chronic lung disease characterized by progressive loss of lung tissue, leading to larger and larger holes in the lung and reducing lung function. Alpha-1 antitrypsin is a protein that prevents digestive enzymes from damaging the body’s own organs, especially the lungs and liver. People who lack this enzyme, even nonsmokers, can get both emphysema and liver cirrhosis.

In medical school, my professor quipped that for every hundred people with emphysema, 90 of them are smokers, one has alpha-1 antitrypsin deficiency, and nine of them are lying. My clinical experience since then has shown me that nonsmokers can indeed get emphysema — through secondhand tobacco smoke, occupational exposure and, in other countries, home-cooking-fire smoke. The way to find out is to test your alpha-1 trypsin level with a simple blood test your physician can order.

As far as diet goes, there are usually no restrictions, although I have seen people with very severe emphysema improve a bit by adding a few tablespoons of peanut butter daily. Peanut butter — high in healthy fat and protein — reduces the amount of carbon dioxide your body makes per calorie taken in. People with severe emphysema also tend to get thin, so a few extra calories are often helpful.

Lung exercises can be very helpful, and usually are supervised by a team of health care providers, including physical and occupational therapists, respiratory therapists, nurses and your doctor. Finally, metoprolol is a good medicine for most people with high blood pressure, but it can cause spasm of the airways, so I would ask your doctor to think about changing that to something else.

The booklet on COPD explains both emphysema and chronic bronchitis, the two elements of COPD, in detail. Readers can obtain a copy by writing: Dr. Roach — No. 601, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow 4-6 weeks for delivery.

DEAR DR. ROACH: I’m 19 years old and way too hairy. I have a mat on my back and chest. Shaving lasts a short time; waxing and laser removal are not an option for me. Is there medicine I can take? It’s embarrassing. — A.W.R.

ANSWER: Some people are hairier than others. Body hair for men goes in and out of fashion, and is out of fashion now. Laser hair removal is effective but expensive. One option would be an over-the-counter hair-removal cream, which usually works well but can irritate the skin. Be very careful to make sure you get the right cream for the body part, and don’t leave it on for too long.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from

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