DEAR DR. ROACH: In a recent column, you recommended “very aggressive treatment” of the COPD in a man who was nearly passing out when coughing due to a cold. I know a man who has been diagnosed who continues to smoke a non-filtered brand of cigarette. His coughing is persistent, and he coughs up phlegm. He is pushing 70, and suffers shortness of breath with minimal exertion. He cannot seem to gain weight despite eating a high-fat and -carb diet. He avoids doctors. Is there anything involved in the treatment you referred to that might ease this man’s condition? Short of giving up smoking, he appears in enough discomfort to want relief. — S.C.

ANSWER: Chronic obstructive pulmonary disease (COPD), comes in two forms, emphysema and chronic bronchitis. Smoking is by far the most likely cause of these conditions. Persistent cough is the hallmark of chronic bronchitis. Smoking causes a progressive, inexorable destruction of the lungs in susceptible people, and the only way to halt its progress is to quit smoking. Apart from quitting smoking, there are some other therapies that can help people with COPD.

Many people with COPD have constricted airways, similar to people with asthma, so inhalers can help open these airways and relieve some of the shortness of breath that comes from COPD. Other types of inhalers help reduce the abnormal, thick mucus that plugs the airways. Steroids — usually inhaled but sometimes taken by mouth, especially during exacerbations — often are used to reduce the inflammation in the lungs.

If the lungs are damaged to the point where oxygen levels in the blood are low, which is quite advanced COPD, then the use of oxygen at home not only helps people feel better but can help them live longer as well. However, oxygen use in current smokers is dangerous and increases the risk of fire. Many physicians are uncomfortable prescribing home oxygen to smokers.

Weight loss with COPD is very common. A healthy, balanced diet is the right approach, with maybe some extra healthy fat, such as peanut butter, which reduces the amount of work lungs need to do, if only slightly.

Medications and oxygen are available only from a physician or nurse practitioner. If he wants relief, it’s time for him to stop avoiding them.

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 have a different response for F.F., the individual who asked about actinic keratoses. The letter makes more sense if you substitute the diagnosis “seborrheic keratosis” into the question. I believe he/she mistook one medical term for another. That would explain why the dermatologist has offered only freezing, why insurance doesn’t cover them, why they’re brown, why they’re on the abdomen and why the doctor charges $30 a pop.

Actinic keratoses are rarely brown and almost never found on the abdomen. What’s more, if this person truly had hundreds of AKs, his/her dermatologist surely would have prescribed fluorouracil cream, imiquimod cream, photodynamic therapy, Solaraze gel or Picato gel to treat them.

Thanks for writing the column. I read it all the time. — KMVDG, M.D.

ANSWER: That makes a great deal of sense. The terms “actinic keratosis” and “seborrheic keratosis” are similar, but they neither look nor act similarly. Actinic keratoses are skin-colored or whitish, rough and occur in sun-exposed areas. They are precancerous. Seborrheic keratoses are brown, raised and often look like they can be peeled off. They are not pre-cancerous, and so removal is typically not covered by insurance.

I thank my colleague, a dermatologist, for sorting it out and for the excellent explanation.

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 ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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