A report in the U.K. newspaper The Sunday Mirror suggesting that 24-year-old singer Amy Winehouse has early signs of emphysema has many wondering how someone so young could be developing a disease that typically affects cigarette smokers in their 50s and 60s.
But some doctors say that early emphysema could be just one indication of the toll that hard living is taking on Winehouse's lungs, adding that the singer may also be suffering from "crack lung," a severe condition resulting from her alleged use of crack cocaine.
A person who has crack lung may experience fever, cough, difficulty breathing and severe chest pain within 48 hours after heavy crack-cocaine smoking. The condition can cause the air sacs in the lungs to become inflamed and scarred.
Back in January, video footage of Winehouse smoking what appeared to be a crack pipe surfaced.
"It seems as if there's a history of crack use and drug use," says Dr. Len Horovitz, pulmonary specialist and internist at Lenox Hill Hospital in New York City. "I would surmise that she probably has had episodes of crack lung before this."
Winehouse's father, Mitch, told The Sunday Mirror that he rushed his daughter to the hospital on June 16 after she collapsed at her home in Camden, North London.
"With smoking the crack cocaine and the cigarettes her lungs are all gunked up," Mitch Winehouse told reporters Sunday. "There are nodules around the chest and dark marks."
While Mitch Winehouse told reporters his daughter has emphysema, Winehouse's U.S.-based publicist, Tracey Miller, has since told The Associated Press, "She is not diagnosed with full-blown emphysema but instead has early signs of what could lead to emphysema."
Doctors say Mitch Winehouse's description of the chest X-ray, which suggests scarring and inflammation, leads them to suspect that crack lung could be the culprit. While emphysema is a chronic condition that develops over time, crack lung is an acute injury to the lung, and could have caused such a sudden trip to the hospital.
"She probably has two diseases: emphysema and crack lung," says Dr. Norman H. Edelman, chief medical officer of the American Lung Association. "They're similar, but not exactly the same."
The lungs contain tiny air sacs, which allow oxygen to enter and carbon dioxide to exit the blood during breathing. Harmful particles in cigarette smoke and other forms of air pollution can irritate these fragile air sacs.
Emphysema occurs when the walls of those air sacs lose their ability to expand and contract. Air gets trapped, so oxygen can't enter the blood as easily. This leads to shortness of breath, coughing and lack of endurance during exercise.
Emphysema is one type of chronic obstructive pulmonary disease (COPD), and is often seen in combination with chronic bronchitis.
Edelman says that an individual's risk for emphysema can often be measured by taking into account their pack-years of smoking — or the average number of packs a day times the number of years smoked. In his patients, he finds that a general marker for emphysema is 40 pack-years, meaning that a person may have smoked two packs per day for 20 years or four packs for 10 years.
Because the damage is usually done slowly, emphysema is a rare condition among young people. Only 7 percent of the 4.1 million Americans living with emphysema are between 18 and 44 years old, the American Lung Association reports.