Wearing a white plastic clamp on his nose, Robert Howard blew through a tube into a machine that measured his lung capacity. That test would help doctors determine whether Howard's four-pack-a-day cigarette habit had led to the early stages of a disease that takes 60,000 lives a year.
Howard is one of more than 10,000 people whom Donald P. Tashkin, UCLA professor of medicine, hopes to test for chronic obstructive pulmonary disease, an illness that includes chronic bronchitis and emphysema.
The free tests, which UCLA began Saturday in Santa Monica, are part of a federally sponsored $32-million study being conducted in 10 cities. Those found to have the progressive lung disease will be asked to participate in a test of a new medication that may help arrest its development.
Researchers will spend up to 18 months testing volunteers who smoke cigarettes and are between 35 and 59 years old. Testing will continue until 600 people with the disease are found in each city who are willing to join the second stage of the study.
For the Record
Los Angeles Times Sunday January 25, 1987 Home Edition Westside Part 9 Page 2 Column 2 Zones Desk 1 inches; 33 words Type of Material: Correction
A caption in Thursday's Westside section identifying Anne Coulson, who was shown demonstrating a lung test that is part of a UCLA study of cigarette smokers, failed to mention that she is a project staff member and not a cigarette smoker.
"This is kind of an underplayed disease," Tashkin said. "This is the first study to focus on chronic obstructive lung disease in a big way. Most other studies have focused on cancer and heart disease."
Chronic lung disease disables about 1 million people in the United States at any one time, Tashkin said. "It takes a while for the disease to manifest itself. If you smoke, you almost always have some damage to your airways. But less than 10% of smokers undergo a process in which that damage becomes progressive to a point that they have a hard time breathing and have a full-blown case."
The disease can result in chronic bronchitis or emphysema, and many victims develop both, he said.
"Chronic bronchitis is a condition in which the air passages are damaged, usually by smoking, and as a result, inflammation and swelling occurs," Tashkin said. In the advanced stage, the passages become scarred and shrink, which results in a "very small airway," he said.
In emphysema, the small air sacs in the lungs are damaged. This reduces the amount of oxygen that is transferred through the lungs to the bloodstream. Like bronchitis, it is a disease that steadily gets worse. "As the walls of the air sacs are destroyed, the lung looses its elasticity and becomes like a flabby balloon," Tashkin said.
Tashkin is looking for subjects who smoke. "Over 90% of all cases are directly caused by smoking," he said. "People who have already stopped smoking have done themselves a service and are not at risk anymore."
Smokers with the early stages of the disease "have lost about 25% of their lung function, which they would not notice," Tashkin said. "These people would not normally come to the attention of physicians." Most people, he added, can lose up to half of their lung function before they realize they have a problem.
Howard, a tall, wiry 44-year-old resident of Venice, said he decided to get the test because "I realize that when you smoke this long you get some lung damage. You reap what you sow."
He began smoking in 1958 when he was 16 and has continued on and off for 23 years.
Howard was told that his test results "were on the borderline." Although he was not asked to participate in the second part of the study, he was advised to stop smoking.
Another smoker who came in for a test was Ray Lewis, 51, a professor of electrical engineering at California State Polytechnic University in Pomona, who said he has smoked up to 10 cigarettes a day for 35 years.
"When I started it was the thing to do," he said. "In those days you could buy a single cigarette for a penny. My friends and I, we would buy one and pass it around, not realizing we could get hooked on it."
Lewis' test results were normal. "I'm really relieved," he said.
If his test had shown evidence of chronic obstructive pulmonary disease, Lewis would have been asked to join the second stage of the study.
Three Groups in Study
Second-stage candidates will be divided into three groups for a five-year study, Tashkin said.
The first group will be given a list of clinics that help people quit smoking. Patients will be referred to doctors if they do not have them. They will be asked to come to UCLA once a year for a breathing test that measures the rate at which their lung capacity declines, Tashkin said.
The second and third groups will be enrolled in intensive stop-smoking programs. Once they have kicked their habits, patients will be assigned individual smoking counselors for the duration of the project to help them stay away from cigarettes. These groups, too, will take annual breathing tests.
In addition, the second group will be given an inhailant called ipratropium. If effective, the drug will help keep patients' airways from narrowing. The third group will be given a placebo. Patients in these groups will not know whether they are receiving the real drug or a placebo.
"We want to answer the research question: Does the medication, when it is used at this stage of the disease, stop the disease from progressing?" Tashkin said.
"But we do not want to present any medication as an alternative to stopping smoking," he said. "So we are offering them all the smoking cessation program.
"People we find in the early stages of this disease probably will be spared if we get them to stop smoking and/or take this medicine," he said. "We cannot restore the lung to a pristine state, but we may be able to prevent lung function from declining at a rapid rate."
Smokers interested in a lung test can call (213) 825-3462 for an appointment or drop in between noon and 5 p.m. Tuesday through Saturday at the study's Santa Monica office, 1415 Third St., Suite 108, on the Third Street Mall.