The Death of Leonard Nimoy: A Lesson on COPD

Everybody loved Spock. But the acting legend behind him, Leonard Nimoy, was diagnosed with a disease that is all too common in EMS contacts. Nimoy was suffering from the effects of Chronic Obstructive Pulmonary Disorder, or COPD. If you were a follower of his Twitter page, you’d notice he tweeted on the symptoms quite frequently, including having to move to lower altitudes because he couldn’t get enough oxygen at his vacation home.

Contrary to the belief of some, COPD is not a specific illness but an umbrella diagnosis that includes several different illnesses but all that have similar effects. The most common ones being taught emphysema and chronic bronchitis, but it really includes ANY obstructive pulmonary disease, like asthma (also VERY common) and cystic fibrosis (not so common). It is the third most frequent justification for home care services, which increases the likelihood we will encounter patients with the disorder.

I’m going to specifically target emphysema, which is what I believe that Nimoy had, based on his physical presentation. This is all what I suspect as a matter of seeing what I could see of his final year in the media, not a review of his medical records or death report. So if details emerge later on that are the opposite of what I’m writing, don’t send me angry emails. This is purely speculation based on observation.

Specifically emphysema, the inability of the alveoli to exchange gases because of overdistention results in the destruction of the walls of alveoli. The word itself is a pathological term that that describes an abnormal distention of the of the air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli (Smeltzer et al, 2004). It is the end stage of a process that has progressed over many years. As the alveoli is destroyed, the amount of surface area that contacts the capillaries decreases and increases the amount of dead space where no gas exchange occurs. Since carbon dioxide isn’t exchanged, hypercapnia results, which leads to respiratory acidosis.

Two main types of emphysema are based on the changes developing in the lungs, panlobular and centrilobular. In panlobular, the patient presents with the typical barrel chest, dyspnea on exertion, and weight loss. This is where you see the need for negative pressure on inspiration and adequate level of positive pressure during expiration.

In centrilobular, there is chronic hypoxemia, hypercapnia, polycythemia (an increase in red blood cell concentration as a response to low oxygen concentration), and right sided heart failure. Right heart failure is a result of the right side of the heart having to maintain a high pressure in order to get enough blood to perfuse. Expect congestion, edema, and JVD, and abdominal pain in the area of the liver, as well as central cyanosis, and respiratory failure.

I’m suspecting that in Nimoy’s case, chronic smoking caused destruction of the cleansing mechanism, and because the respiratory tract couldn’t move secretions and other obstructions, air became trapped in the alveoli causing distention. Ironically, there is an increase in mucous production furthering irritation. Over time this is troublesome because the damage is cumulative. Smoking isn’t the only risk factor for COPD, but it and exposure to second hand smoke account for 80-90% of COPD cases.

In Part II, I’ll discuss clinical manifestation, diagnostics, as well as treatment strategies for emphysema.