World COPD Month

By Dr. Christine Fukui
Interviewed by Rasa Fournier
Wednesday - November 03, 2010
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Dr. Christine Fukui

Where did you receive your schooling/training?

I went to University Lab school here in Hawaii. I went to medical school at the University of California, San Francisco, and did all my training there - my internship, residency (I was the chief resident) and my fellowship. Then I came back to Hawaii and worked at Kaiser for 29 years. I just retired, and now I just started working at Tripler.

What does the practice of pulmonology entail?

Pulmonologists do lung disease, critical care and sometimes sleep disorders. What I’m doing now is just sleep, but for 29 years I did pulmonary and critical care and sleep. The most common problem in sleep is sleep-disorder breathing, so it’s in the pulmonary realm.

What are the most common pulmonary problems?

Asthma and COPD (chronic obstructive pulmonary disease). We also see cancer and lung disease related to occupations, so asbestos and other kinds of dusty occupations. We treat fibrotic lung diseases, which are less common but very bad in terms of treatment mortality. There are diseases related to blood-vessel disorders, so pulmonary hyper-tension is another disease we take care of.

What is COPD?

It includes emphysema and chronic bronchitis. Right now COPD is the fourth leading cause of death in the U.S. and the world. It’ll be the third leading cause of death by 2020, yet the amount of money that’s spent on drugs and research is so small. Unfortunately, COPD is not very sexy. It doesn’t affect children or young women. Because people associate it with smoking, it’s like, “Well, you smoke, therefore you should have known better,” when in fact, people have COPD and have never smoked. I have patients with hereditary forms of emphysema and COPD.

With COPD, a lot of people are not diagnosed or diagnosed very late, usually when they’ve lost over half of their lung capacity. We all have two lungs, and there’s a lot of excess. I had a young man who had one whole lung removed and he ran a marathon. Most people don’t stress the system that much - they walk around, climb a few stairs. Before they have symptoms that might cause them to see a doctor, they’ve already lost more than half of their lung capacity. From losing three quarters of lung function to dying happens in a small amount of time.

The big push is to get people diagnosed early, before they have significant symptoms, so you can treat them and prevent them from having symptoms. Educating people about COPD, getting people diagnosed, getting people to quit smoking is very important.

Why is the rate of COPD expected to get worse, rather than better?

While many diseases have leveled off or are going down - we’ve made strides with heart disease, cancer, strokes - COPD is going up. It’s related to smoking. If we can get smoking cessation, then that should improve. If you are a smoker over 40, or a former smoker, you should have your lungs tested. If there’s a history of bad lungs in the family, you should especially get tested and stay away from smoking, because there is a genetic component. The incidence of asthma is also rising; we’re not certain why.

COPD has many different causes in different countries. In underdeveloped countries women cook with fire in huts and they breathe in all that smoke. So, they don’t smoke, but they get COPD.

Dr. Christine Fukui conducts a lung test on Valerie Chang, executive director of the Hawaii COPD Coalition

Is all smoke bad?

Most people who have lung disease are irritated by any kind of smoke or dust. Even if you don’t smoke, if you’re around secondhand smoke it can have an effect on your lungs. I’ve had several women patients who didn’t smoke, but their husbands smoked and the women got the lung cancer.

What demographic is most affected by lung disease?

Men and women - equality in smoking, equality in disease. There are some adult patients who were born prematurely or who had a severe lung infection as an infant. Your lungs aren’t fully developed until you’re 8 or 10, so any kind of infection as a child has a more profound effect on how your lung eventually develops.

Is Hawaii’s environment good for people with lung disease?

I worry about vog, particularly on the Big Island. It affects people who already have lung disease. The big question is, does it cause lung disease particularly in young children? The university is doing studies, we don’t have any big results yet. Most people feel humidity is worse for asthma. The three major things that exacerbate allergic asthma are cats, dust mites and cockroaches (roach droppings).

Are fireworks detrimental to lung health?

Yes, yes, yes, yes! Fireworks are bad. Culturally, it is not important to shoot off those huge aerials that are illegal, or the huge strings of firecrackers. For people who have lung disease, fireworks are really bad. And asthma, we have one of the highest rates here in Hawaii, so there’s a lot of people with lung disease.

Is there any “safe” way to smoke?

No. There’s no good way because there’s nicotine plus all of the other chemicals.

Is marijuana safer?

The only reason would be that people cannot smoke as much marijuana as they can cigarettes.

Are electric cigarettes safe?

They’ve been outlawed. They don’t know what’s in them. It’s nicotine plus whatever.

Does smoking cause irretrievable damage?

There is some damage. The rate of decline of lung function is greater in smokers. If you quit smoking, the decline returns to normal; it slows down. The bad effects of smoking on the heart, in terms of heart attacks, that goes down almost immediately. People say, “Oh it’s too late, I smoked for a long time.” It’s never too late. Now, there are more medications you can take, nicotine replacements and support programs to help.

Is it possible to quit smoking in all cases?

People go through stages of readiness for change and you can be at the precontemplative, the contemplative, etc. You can change and progress. It depends on the desire to quit. One patient, I couldn’t get him to quit. When he got cancer related to smoking, all of a sudden, he quit, boom, just like that.

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