SUNDAY MAGAZINE

Damage to the lungs

HEALTHWATCH

DR. R. NARASIMHAN

Stop smoking: Smoking is responsible for majority of COPD cases.

Stop smoking: Smoking is responsible for majority of COPD cases.  

CHRONIC Obstructive Pulmonary Disease (COPD) is a lung disease that is progressive and not fully reversible. COPD obstructs the airways and makes breathing difficult. Patients with COPD, who include those with chronic bronchitis and emphysema, have symptoms such as cough, mucus production and shortness of breath, when walking even a short distance.

World COPD Day is an annual event aiming to raise awareness of this little-known, but widespread disease. Over 900,000 people in the U.K. are diagnosed with COPD, and an estimated 2.1 million have it, but don't know they do. In India we do not have statistics but I am sure the incidence is much higher mainly due to increasing population.

This year, World COPD Day is on November 16. The theme "COPD: Read The Warning Signs". It affects breathing to the point that even simple everyday tasks — such as talking, bathing, dressing, and taking short walks — become difficult.

Given that more than half of the estimated number of COPD patients are not diagnosed, we need to create greater awareness about this disease and its symptoms and encourage patients to seek lung function testing (also known as a spirometry test). If diagnosed, there are effective treatments that can help improve patients' lung function and quality of life. Although there is no cure for COPD, there are treatment plans that can help patients manage the condition, provide symptom relief and slow the progression of the disease

COPD is a progressive and often debilitating lung disease. Long-term smoking — the most common cause of COPD — is responsible for 80-90 per cent of all cases, while other risk factors include heredity, passive smoking, air pollution, a history of frequent childhood respiratory infections, and exposure to occupational dusts and chemicals. Common symptoms include shortness of breath, chronic coughing and increased mucus production.

There is an urgent need to increase awareness because of the increasing pollution and smoking habits among the young. This is more so because most people are not aware that they are suffering from this disease. Smoking affects the small airways. There are no tests to identify the abnormalities of the small airways in a routine pulmonary function lab. So the pulmonary function test will show normal. Hence most patients continue smoking despite advice to the contrary.

Thus the most important risk factor for COPD is smoking. Passive exposure to tobacco smoke also contributes to respiratory symptoms and COPD. Other documented causes of COPD include occupational dusts and chemicals (vapours, irritants, and fumes), and indoor air pollution from biomass fuel used for cooking and heating in poorly vented dwellings. The World Health Organisation (WHO) estimates that there are 4,00,000 COPD deaths a year from exposure to biomass fuels. Outdoor air pollution adds to the total burden of inhaled particles in the lungs, although the specific role of outdoor air pollution in causing COPD is not well understood. Respiratory infections in early childhood are associated with reduced lung function and increased respiratory symptoms in adulthood. COPD occurs in both men and women.

A common doubt is whether COPD and asthma are the same? The answer is no. There is undoubtedly an overlap between asthma and COPD. There is evidence that long-standing asthma or non-usage of steroid inhalers for asthma can lead to changes in the structure of the airways and partly irreversible airflow limitation. Individuals with asthma who are exposed to noxious agents that cause COPD may develop a mixture of "asthma-like" inflammation and "COPD-like" inflammation.

COPD treatment hinges on stopping of smoking. Drugs can be used to decrease the symptoms caused due to infection but the disease process cannot be reversed. The U.S. National Heart, Lung, and Blood Institute and the World Health Organisation, recognising the increasing importance of COPD as a public health problem, have collaborated to initiate the Global Initiative for Chronic Obstructive Lung Disease (GOLD) programme. The programme offers a framework for management of COPD that can be adapted to local health care systems and resources.

There is an urgent need for making the government, medical community and the public aware of the gravity of COPD incidence in India.

The writer is a Senior Consultant in Respiratory Medicine based in Chennai. E-mail him at drnarasimhan@gmail.com