Yet last week's disclosure that the 24-year-old has "signs of emphysema," according to her U.S. publicist, Tracey Miller, shocked many. Though copious photos show the beehived songstress with a cigarette dangling from her lips, it seemed stunning to learn that someone that age could suffer from a disease usually associated with two-pack-a-day 65-year-olds.
But, in fact, Winehouse is not an anomaly. Health experts say that young adult smokers are no strangers to mild emphysema, a shortness of breath caused by damage to the lung's small air sacs. Smoking can permanently deteriorate the lungs, irreversibly diminishing lung capacity -- and the damage starts young, even in teens who smoke five cigarettes a day, according to one 1996 study from the Harvard School of Public Health and the Brigham and Women's Hospital in Boston of 10,000 youths who smoked.
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But many smokers don't show symptoms for years, leading them to believe no damage is being done when, in fact, it is accruing all the time. "Teenagers and people in their 20s think they're invincible," says Dr. Norman H. Edelman, chief medical officer for the American Lung Assn. "They think they can wait until they're 35 to stop smoking and everything's going to be fine, but they can do permanent damage before that."
The damage can come in the form of emphysema, which is caused by some of the 4,000 to 5,000 toxic chemicals in cigarette smoke. (None in particular are known to be the source of the damage, but collectively they create chaos in the lungs.) Activated oxygen molecules in the smoke trigger inflammation that can't be controlled, says Dr. Jonathan Samet, chairman of the epidemiology department at the Johns Hopkins Bloomberg School of Public Health in Baltimore.
Even in early stages of emphysema (defined generally, Samet says, as having less than 80% lung function), the chemicals are breaking down the lung's tiny air sacs, called alveoli. The consequence: "A grape-like cluster of tiny air sacs becomes one big sac, which means there is less area to exchange oxygen," Edelman says.
Inflammation, Samet says, reduces the air sacs' elasticity, making it harder for them to expand and contract, moving air in and out. "It's like the difference between a balloon filled with air and a paper bag filled with air."
As well as emphysema, Samet adds, smoking can cause chronic bronchitis, lung inflammation characterized by irritation and scarring. "There are a lot of extraordinarily irritating substances in tobacco smoke. The lung has defense mechanisms that can clean out things that get in. But smokers dump so much toxic stuff in that the lungs can't keep up."
Adding illegal drugs to the mix -- such as marijuana and crack cocaine -- can exacerbate the problem, although experts aren't sure if either directly causes emphysema. "It basically compounds the issue," says Dr. Zab Mosenifar, medical director of the Women's Guild Lung Institute at Cedars-Sinai Medical Center.
Edelman says that some of the bronchitis inflammation is reversible, but the lung damage of emphysema is not -- and continuing to smoke results in less and less lung function over the years. (Everyone's lung function declines with age, but that of smokers declines at a faster clip.)
Young adults with mild emphysema might notice slight physiological changes -- a pickup basketball game becomes more arduous, or lugging groceries produces a little wheezing. A singer such as Winehouse may not be able to hold long notes with ease.
Others -- especially if they're inactive -- may not have symptoms until later in life. "Unless you're a marathon runner, you're not using your full lung capacity," Edelman says. "Someone living a normal life might not feel anything, and that's the big problem. They don't feel anything until they lose 40% to 50% of their capacity."
Winehouse isn't the first young celeb linked to emphysema. Model Christy Turlington disclosed in 2000 at age 31 that she had mild emphysema, the result of a 10-year smoking habit that started when she was a teenager (she quit in 1995). At the time, Turlington was quoted as saying about her diagnosis, "The really frightening thing is that there was enough of an effect from my smoking that it caused permanent damage." Her father died of smoking-related lung cancer.
The good news is that overall, fewer young adults are smoking. In 2006, 24% of 18- to 24-year-olds smoked, down from 34% in 1983, according to the national Centers for Disease Control and Prevention.
Not 'Grandpa's disease'
Damage can be seen via CT scans, MRIs and lung function tests. Quitting smoking is the best way to stave off further lung damage. Experts say mild emphysema usually isn't treated with medication unless asthma is also involved.
Winehouse's doctors, Miller says, "expect a full recovery based on the treatment she's going through," although the publicist didn't specify what that treatment is. Unfortunately, Winehouse doesn't seem to have kicked the habit yet: She was spotted lighting up last week after leaving a London hospital. Perhaps others will learn from her example: "If there's any silver lining," says Mosenifar, "she may have a positive impact on young smokers. . . . A lot of young kids think this is Grandpa's disease."
Dr. Mark Eisner, associate professor of medicine at UC San Francisco, says the take-home message isn't for young smokers to flock to get lung function tests. Rather, what they need to do is "stop smoking," he says. "If their lung function is preserved, it doesn't mean it will continue to be."
For a list of resources online, go to latimes.com/quitsmoking.