June 24, 2008 -- 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."
What's the Difference?
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.
"A 24-year-old presenting with emphysema is unusual," says Dr. Albert Rizzo, speaker for the American Lung Association nationwide assembly.
One explanation for a 20- or 30-something who is experiencing the early stages of emphysema is a specific genetic defect, Rizzo says. People who have this inherited condition lack a protein that protects lung tissue from breaking down. This genetic problem can be found through a blood test and treated through medications that replace the missing protein.
If Winehouse doesn't have this genetic abnormality, though, her alleged crack cocaine use could be the culprit.
Cocaine causes blood vessels to constrict, which leads to increased blood pressure in the lungs, says Dr. John Spangler, director of tobacco intervention programs at Wake Forest University School of Medicine. If these blood vessels constrict for a long period of time, such as during heavy crack-cocaine use, blood and oxygen can't through the lungs. This results in scarring and permanent damage.
Doctors typically detect emphysema or crack lung in a chest x-ray, MRI scan or lung function test after a patient complains of chronic shortness of breath and coughing. But these symptoms may come years after the problem begins.
"The lungs have an incredible amount of reserve power," says Edelman. "They were designed for chasing lions in the forests. A fair amount of lung function can be lost before people notice it, unless they are competitive athletes."
Whether or not Winehouse was suffering from a loss of lung function at the time of her admission remains a mystery. Edelman says such symptoms are unlikely in the early stages of the disease.
"I doubt that she has symptoms if she is still blessed with singing," Edelman says.
Risky Habits Mean Permanent Damage
Emphysema isn't just a condition for the heavy smokers, however.
"Emphysema is really an aging process of our lung that we will all go through if we live long enough," Rizzo says.
The air sacs in our lungs naturally break down as we age, but cigarette smoking and other drugs can speed up this process, causing irreversible damage.
"The lung doesn't regroup," Edelman says. "It doesn't repair itself. Once the damage is done, it's done."
Thus, the first step to preventing and treating both crack lung and emphysema seems easy: "Don't smoke anything. If you're smoking anything, stop it," Horovitz says.
But for many, that part is far from simple. Spangler says he deals with people who are addicted to smoking every day, and sees them struggle to break the habit. Certain people may need more intense smoking cessation programs, including medication and counseling.
"But it's essential to quit," Spangler says.
Along with quitting, treatments that slow the progression of emphysema include inhaled steroids to treat lung inflammation and other inhaled medications to open up the airways.
But because Winehouse is so young, permanent damage done to her lungs may eventually require a more radical treatment to keep her healthy as she gets older.
"The thing you start thinking about is a lung transplant," Rizzo says.