When World Chronic Obstructive Pulmonary Disease (COPD) Day was observed recently, the focus of attention was on a subject that is becoming an extremely urgent hearth issue to chest physicians across the world and in Sri Lanka: namely, the long and short term damage of Chronic Obstructive Pulmonary disease to a person’s body. While this common chronic lung disease affects men and women the good news is that it is both preventable and treatable chronic lung disease.
Consultant Respiratory Physician, District General Hospital and District Chest Clinic, Trincomalee Dr. Upul Pathirana shares his expertise on this important health issue with the Sunday Observer on preventable risk factors causing it especially smoking and inhaling impure indoor and outdoor air emissions. Most importantly he also shares some simple rules to avoid these risks.
Q: When World COPD (Chronic Obstructive Pulmonary Disease) Day. ( Nov 16) was observed recently) I understand this year’s theme was “Lungs for Life.” Could you explain its significance to persons afflicted by this chronic lung condition.?
A. “Your Lungs for life, “is the theme for World COPD day 2022. Its message to all those who are not afflicted with COPD or already afflicted by the condition, is that keeping lungs healthy is a vital part of one’s future health and well being.
It is a process that starts from early childhood when the lungs are still developing, to the time one reaches adulthood. In order to create awareness of the important role of the lungs in our well being that the Global Initiative for Chronic Lung Disease ( GOLD) has selected this as a theme for this year’s COPD Day.
Q: With reference to what you just pointed out, COPD is a common respiratory disease across the world and keeping one’s lungs healthy plays an important role in one’s well being. Unfortunately many people still lack even basic knowledge of this condition-. Could you explain what exactly COPD is , and its adverse effects on our health?
A. COPD is a disease, which affects lungs making it hard to breathe. In patients with COPD, the airways (the branching tubes that carry breathing air within the lungs) are narrowed and can be clogged with secretions called mucus. The air sacs are also damaged. These combinations make patients feel short of breath and tired.
Q: Is Emphysema or chronic bronchitis the same thing? What is the difference?
A. Emphysema means damaged air sacs and air gets trapped inside the lungs making it harder to breathe in again. Breathlessness is the main symptom of emphysema. Constant and long-lasting irritation and swelling of the airways is the hallmark of chronic bronchitis. It is characterized by coughing and increased production of secretions called mucus. These are two different components of COPD.
Q: How is COPD caused?
A. Smoking is the most common cause of COPD globally. The noxious particles in smoking induce an inflammatory (immune reaction to injurious agents) cascade within the lungs. The damage incurred by smoking is permanent and causes COPD.
Q: Can symptoms of its onset be detected early?
A. The patient may not feel any symptom until the lung is damaged to a certain extent. As the severity of illness is getting worse, you may experience breathlessness, mainly when you are engaged in physical activities like walking. Your breathing might be noisy (“wheezing”) similar to that of bronchial asthma. Chronic cough with phlegm may cause further trouble.
The clinical course could further complicate with infective exacerbations and COPD patients are at risk of developing lung cancer and heart diseases.
Q: Main risk factors- what are they?
A. Smoking is the commonest causative factor for COPD although exposure to other toxic gases and fumes may induce COPD. Untreated long-standing bronchial asthma patients may behave like COPD. Indoors and outdoors air pollution are well-known risk factors to develop COPD and these can precipitate COPD flares as well. Alpha 1-antitrypsin deficiency is a rare genetic disorder associated with COPD.
Q: Is there a test/s to confirm the diagnosis?
A. Yes. Spirometry will help to establish the diagnosis. During this test, you will be advised to take a deep breath and then blow out as fast as you can into a tube. The tube is attached to a computerised system so that it can measure how much air you can blow out of your lungs and how fast you can blow. If the result is abnormal, the test is repeated in 15-20 minutes after an inhaled or nebulised medication. The second test aids to decide whether the abnormal results are reversible with medication and make alternative diagnosis like bronchial asthma.
Q: Do you offer tests other than spirometry?
A. Testing other than spirometry is individualized. Imaging your lungs with chest X-ray can show changes compatible with COPD although computed tomography (CT) of the chest is more accurate at detecting and characterizing emphysema. CT has other advantages like detection of early stage lung cancers for which COPD patients are at high risk.
Q: Can COPD be cured?
A. It cannot be cured and can get worse over time. However, there are treatment options to control symptoms and disability in COPD. There are therapeutic measures that prolong survival
Q: Will early diagnosis and treatment help?
A. It is important as removal of causative factors and can slow down the progression.
Q: What are the complications of persistent COPD? Is pneumonia one?
A. COPD is a progressive disease, and the trajectory may complicate with flares of disease, which could be non-infective or infective (pneumonia). Patients may end up with respiratory failure (a state of low oxygen in blood) and the pressure within the lung may go up (called pulmonary hypertension). Then, your right heart ultimately fails.
Q: Will regular exercise, nutritious diets help?
A. Eating healthy foods with a balanced meal improves your overall health. Patients with COPD can lose body weight and muscle mass because of disease itself (chronic inflammation) and lack of physical activity. The result is a lean patient with low body mass index (BMI), which is associated with poor outcome in these patients. Supervised regular exercise plan is an essential component in COPD management to reduce disability.
Q: Treatment options?
A. Your physician will stage the disease based on your clinical characteristics and spirometry results. The main forms of medicinal treatment are inhalers, which help to open and dilate the closed or narrowed airways. Thereby, the inhalers enhance your exercise capacity. Additionally, the doctor might prescribe pills and capsules as required, especially in flares of symptoms.
As the disease progresses, your lung fails to oxygenate the blood for the demand necessitating home oxygen therapy. On rare occasions, surgeons can help COPD patients with surgical interventions as decided by a multidisciplinary team led by a respiratory physician. Finally, replacing your disease lung with a donor lung (lung transplantation) is going to be the last option.
Q: You referred to flare-ups. What are they?
A. The disease is marked by the progressive nature of the disease over time. There may be rapid worsening of symptoms precipitated by an infection, exposure to toxic gases or fumes or related to any other stressful event. These are called acute exacerbations or flares. The other complications such as pneumothorax, heart attack, blood clot within the blood vessels inside your lungs (pulmonary embolism) or rhythm changes in your heart may mimic flares.
The flares could be mild or severe enough requiring hospitalized management to save your life. You should seek medical advice early in flares.
Q: Are there vaccinations to reduce risks?
A. Infections like influenza, pneumonia, Covid-19 can be very hard on your lungs and can cause COPD symptoms to flare up. Getting a vaccine against these bugs can lower the risk of flares. These include the pneumococcal vaccine at least once, the flu shot every year and the Covid -19 vaccine and boosters.
Q: Pulmonary rehabilitation for COPD is included in the Package of Interventions for Rehabilitation, currently under development as part of this WHO initiative. Can you elaborate on this?
A. COPD patients are chronically breathless, limiting their mobility and physical activities, which subsequently causes muscle wasting.
Therefore, you feel tired and weak despite well-controlled COPD with your medications. Targeted exercise sessions in a specialised institution supervised by a respiratory physician and physiotherapists enable patients to engage in activities at home to regain lost muscle power. This type of training programes are coupled with nutritional assessment and appropriate advice, and also psychological support. The whole programe is named as pulmonary rehabilitation, is happening in respiratory units in Sri Lanka with encouraging feedback from participants. .
Q: It has now been universally accepted that reducing exposure to tobacco smoke is one of the most important primary prevention of COPD. Do you agree?
A. Prevention or minimisation of tobacco exposure is the best measure in COPD control as it primarily prevents disease occurrence and mortality, thereby reducing the health care burden and impact on the economy. Quitting smoking is the first and most important step in COPD management.
It not only helps in COPD but also reduces the other complications associated with smoking, for example lung cancer, heart attack or stroke. No matter how much and how long you smoked, you must cease smoking for a healthier life.
Q: Any suggestions as to how a habitual smoker can quit smoking ?
A. Following are several options we have for those who have difficulty complying with this most important intervention in COPD. They include :
a) Nicotine replacement therapy
b) Motivation and counselling for cessation of smoking at all the stages including even if you have not thought of quitting To help make this a reality, WHO introduced the following MPOWER measures.
1) Monitoring tobacco consumption and the effectiveness of preventive measures
2) Protect people from tobacco smoke
3) Offer help to quit tobacco use
4) Warn about the dangers of tobacco
5) Enforce bans on tobacco advertising, promotion and sponsorship
6) Raise taxes on tobacco
These measures are intended to assist in the country-level implementation of effective interventions to reduce the demand for tobacco, contained in the WHO FCTC
Q: Your message to readers?
A. You buy diseases such as COPD, cancers, vascular diseases (heart attack, stroke) each time you smoke tobacco.
You spread these diseases to your loving relations, parents, children and friends, as passive smoking is also associated with tobacco related health issues.
My first, second and third message is quit smoking today, do not postpone it for tomorrow.