THE music in the cellar at the 606 Club in Fulham was not traditional black American blues last weekend but New York jazz. John Serry, the American jazz musician, was playing the piano to a packed room. Even if the fans weren’t listening to the blues, they were breathing in an atmosphere blue with tobacco smoke.

Though as many as 50 per cent of smokers eventually develop chronic bronchitis and emphysema, now known as chronic obstructive pulmonary disease (COPD), there is less public awareness about this than about the association between smoking and lung cancer, or smoking and heart disease. COPD is also a common killer, and in some ways chronic bronchitis and emphysema are more of a challenge than coronary heart disease for smokers. COPD is the only major cause of death that is increasing in the UK, whereas the death rates from heart disease and strokes are declining as a result of improved treatment. Conversely, the prognosis for smokers who develop chronic chest conditions isn’t improving so quickly.

Eventually, one in three patients with COPD will be admitted to hospital with an acute exacerbation of their lung condition. More than half will require treatment in an intensive care unit, where one in ten will die. Those who are dangerously ill but are later fit enough to be discharged should not make long-term plans: a third will die within six months, and just under a half will be dead within a year.

Those who struggle along at home once the COPD has become established find the quality of life much lowered. A survey by the British Lung Foundation last year showed that increasing breathlessness interfered with plans. It hindered nearly half of those with chronic lung disease from going to a restaurant or pub, more than a third from attending family gatherings and slightly under a third from going to a cinema. It prevented grandparents from playing with, or reading to, grandchildren, shopaholics from pottering around the shops, dromomaniacs from going on holiday, and golf players from completing the course. COPD and arthritis are more common causes of abandoning a sex life than impotence.

The current opinion is that COPD would not become such a menace if it were treated earlier. Unfortunately, its early stages tend to be neglected because its advance is insidious. A recurrent cough with production of sputum, the hallmarkof chronic bronchitis, is dismissed as a smoker’s cough. Likewise, the slow advance of emphysema, the progressive breakdown of the walls of the air sacs in the lungs that absorb the oxygen into the circulation, is so slow in its early stages that it is too often disregarded as the breathlessness of middle age.

Early treatment of damage already done by smoking, and stopping smoking are the two most important measures needed to defeat COPD. Some smokers avoid visiting the doctor’s surgery lest they receive a lecture about the absurdity of disregarding the effect smoking has on long-term health. Patients must also overcome their anxiety about seeing doctors, just as doctors must learn to give advice without being judgmental. It is surprising that doctors can adopt the sort of holier-than-thou approach to smoking which, if they were working in a clinic treating sexually transmitted diseases, would have prompted the suggestion that they might like to transfer to a less sensitive branch of medicine.

The drill for treating COPD inevitably includes using inhalers of one sort or another as the airways become narrowed, from inflammation and constriction of the muscles around the bronchial tubes. Short-acting broncho dilators, such as selective beta agonists like salbutamol, are needed for symptomatic relief, as well as long-acting broncho dilators in established disease.

Once the COPD is severe, steroid inhalers are thrown into the battle. Steroids act as anti-inflammatory agents, and include Symbicort, a combination of a steroid budesonide and a selective beta agonist eformoterol fumarate. Antibiotics are important adjuncts necessary to treat intercurrent infections, which may cause exacerbation of the COPD.

It is now particularly important that patients with progressive cough, shortness of breath, wheeze and excessive sputum production, particularly symptoms that are made worse by respiratory infections, should keep in touch with their doctors and practice nurses. The inhalers, a mainstay of their treatment, are being altered to be in accord with regulations about the use of CFCs and the prevention of global warming.

Many patients are already less than proficient with the existing inhalers. Now is the opportunity for all patients with chronic bronchitis and emphysema to learn about the updating of their inhalers and to be shown how they should be used. The target date for the completion of the changeover from CFC inhalers to those which it is hoped will be kinder to the ozone layer is 2005.

• Rosacea: The icy north winds have exacerbated the complexions of those readers who suffer from rosacea. Avene, manufacturer of the anti-redness light moisturisng Diroseal cream, has been in contact to say that its products should be in Boots in early April.