DEAR DR. ROACH: I am male, age 65. I exercise regularly. A shortness of breath led me to get a chest X-ray, which showed that I have emphysema. I smoked for 10 years, but quit 33 years ago. As an avid runner, this revelation was perplexing and depressing.

Is it possible that other factors contributed to me getting emphysema, and how do I minimize this disease, if possible? — T.W.

ANSWER: Emphysema is most often caused by smoking in North America or by cooking fires in many parts of the world. The exact type of emphysema you have can help tell what caused it, but that usually requires a biopsy, which is generally unnecessary for a diagnosis or treatment.

Although X-rays and CT scans can help with the diagnosis, the definitive study is the pulmonary function test. For this test, you must breathe in and out for more times and in more ways than you ever thought was possible with a respiratory technician and a lot of machines. (When I was a fourth-year medical student, I had my own PFTs done as a learning experience — thank you, Dr. Julian Solway — and have respect for how hard they are to perform correctly.)

Besides smoke exposure, another cause is the genetic Alpha-1 antitrypsin deficiency, which can affect the liver as well. This diagnosis is made by blood testing and confirmed by DNA testing through a genetic counselor. I always consider this diagnosis in a person with emphysema who is a nonsmoker or has minimal smoking history. If you do have AAT deficiency, there may be other treatments available, but specific treatment requires special expertise.

Regardless of the cause behind your emphysema, you have already made the most important change by quitting smoking. Avoiding secondhand smoke and other lung irritants is important, too.

There are no treatments to reverse emphysema, but many can improve symptoms. These include medication (such as inhalers), pulmonary rehabilitation and oxygen in people with emphysema that is severe enough to cause low blood oxygen levels. Most people who quit smoking have a very slow progression of the disease. However, it’s important to quit smoking as soon as possible so that there is enough reserve lung function.

Collagen peptides powder

DEAR DR. ROACH: I am a very healthy 74-year-old woman. I don’t take any medications other than a Prolia injection twice a year. I recently started taking 20 g of grass-fed collagen peptides powder, which contains all kinds of amino acids. Will this benefit my hair, skin, nails and joints, as the label suggests? — S.H.

ANSWER: I’d like to tell you it will help, but there isn’t a lot of evidence it does. My anecdotal experience has shown me that only a few people get benefit.

It is true that deficiency of amino acids can lead to poorly grown skin and nails, but it’s not at all clear that giving extra collagen will help people who have a healthy diet.

Just to put things in perspective, 1 cup of chicken or beef stock contains about 10 g of collagen, which your body then breaks down into amino acids. I’m guessing that would be less expensive than the supplement.