Pulmonary disease, a major concern

The chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. What’s more worrying is that this disease causes four times more deaths in India, compared to the US and Europe.

It is a progressive and life-threatening disease that is snowballing into a major public health issue in India. The estimated burden of COPD in the country is 22 million which is much lower than the actual burden. This can be attributed to low disease awareness, lack of early diagnosis and wrong diagnosis. Some studies claim that 25%-50% of people with clinically significant COPD are ignorant about it.

The patients of this disease find it hard to breathe and being a progressive disease, it gets worse over time. What can patients battling COPD do about it? A thorough understanding of the causes, symptoms, the correct line of treatment and the precautions to be taken is important.

Smoking, a risk factor

People who suffer from COPD are usually long-term smokers, which is the root cause of the disease. Many people, who succumb to it after the age of 60 are long-term smokers. Those exposed to pollutants, biomass fuel, industrial dust and chemical fumes for long periods of time also run the risk of developing COPD.

Non-smokers who are exposed to cigarette smoke over a long period can develop the disease. At times, a genetic defect that leads to alpha-1 anti-trypsin deficiency may also be responsible for COPD in some people. This condition is characterised by the body’s inability to make enough protein to protect the lungs from damage.

People who smoke and suffer from this deficiency generally start to have symptoms of emphysema as early as in their 30s and 40s while people who don’t smoke can develop symptoms in their 80s.

Continuous coughing which refuses to stop, sometimes results in the coughing out of mucous. Exercising or any kind of physical activity can lead to a shortness of breath, a feeling of tightness in the chest, bluish discolouration of finger nails and lips and recurrent respiratory infections.

When people are diagnosed with COPD, they tend to become physically less active which leads to a further decline in their health because decreased physical activity can worsen the lung functioning as well as the overall health of a person.

Long-term care

For COPD, inhaled form of medication is preferred over tablet or syrup as they directly reach the lungs where the exacerbations occur. Preventing this is one of the primary goals of long-term care for the patie­nts. These episodes have a detrimental effect on quality of life and disease progression, contributing to further lung function decline and, in severe cases, hospitalisation and even death.

The long-acting muscarinic antagonists (LAMA) and long-acting ß2-adrenergic agonists (LABA) combination has shown more control over COPD symptoms as compared to inhaled corticosteroids (ICS) and LABA.

A study published in the New England Journal of Medicine called FLAME compared the efficacy of two drug combinations in the treatment of chronic obstructive pulmonary disease.

The study revealed that these combinations showed a significant improvement in the reductions of exacerbation (of symptoms), improved lung function and also improved quality of life in COPD patients.

The results of the FLAME study are said to have important implications for the care and management of people living with COPD especially in India that has a high prevalence of the disease.

Patients suffering from the disease should follow a healthy lifestyle and nutritious diet routine. Daily morning exercise schedule needs to be followed religiously. The patients should avoid smoking (completely) and drinking. They should avoid going to highly polluted areas or should carry masks. Patients should know the trigger factors and protect themselves from them. Medication should be taken on time.

The COPD is a chronic disease and hence its management is crucial. It poses enormous burden in terms of morbidity and mortality globally and in India. It also poses a huge economic burden in terms of direct and indirect costs. However, with new and correct treatment in place, COPD patients can be assured of a better quality of life.

(The writer is Senior Consultant, Pulmonology, Interventional Pulmonology and Critical Care Medicine, Apollo Hospital)

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