DR (BRIG) SARVINDER SINGH
In the wake of urbanisation and modernisation although we are making our lives comfortable, at the same time our health is being affected the most. The air that we breathe is laden with a layer of poisonous pollutants and gases to an extent that it is posing risk to our lungs and is causing serious damage to the respiratory tracts and result is rise in cases of asthma and progression in respiratory ailments like chronic obstructive pulmonary disease (COPD). Infact, it is predicted to be the third most common cause of death and fifth most common cause of disability globally by 2025. And if we go by WHO estimates, approximately 80 million people are battling moderate to severe COPD these days.
It is exposure to such micro-particles emitted from vehicular emissions, wide scale industrialisation, construction activities, and exhaust coming from cars which is a mixture of combustion gases and ultrafine particles coated with organic compounds that result into obstructive airway disease like COPD. The moment these particles enter our respiratory tracts, these pollutants can activate an inflammatory cascade that results in severe damage to our lungs.
Though the problem is prevalent among smokers, elderly or individuals confined to rural areas where use of biomass and exposure to chullah smoke was making things worse as people were exposed to fumes from burning fuel for cooking and heating in poorly ventilated spaces. But now due to various kinds of pollutants, soot and carbon particles in the air which is aided by changing weather, smog, etc. is affecting the people in the city.
COPD primarily destroys lungs but along with causing breathing problems and lung infections, it can even lead to various heart problems and can cause a stroke. In fact, it has become a multi organ disease where all organs including our bones get affected.
What is COPD?
Now that we know the cause of Chronic Obstructive Pulmonary Disease (COPD) which is characterised by narrowing of the airways, it is important to understand how the disease affects our health. In larger airways, the inflammatory response is referred to as chronic bronchitis. At times it may even lead to destruction of tissues lining our lung's passage and cause "emphysema"- a long-term and progressive disease of lungs.
Although smoking accounts for most patients with COPD, exposure to air pollutants play an important role too. Basically, in a patient suffering from COPD, diffusion of oxygen from air to the blood is hampered hence adequate oxygen doesn't reach the bloodstream through lungs and more amount of carbon dioxide is retained in the body, causing difficulty in breathing.
About 50 percent of COPD cases go undiagnosed during physical examination. And the symptoms don't appear until significant lung damage has already occurred which only worsens over time. But a chest x-ray and pulmonary function test can diagnose and reveal the progression of the disease.
For chronic bronchitis, the main symptom is persistent cough along with mucus (sputum) production for at least three months FOR TWO CONSECUTIVE YEARS. However, other symptoms may include shortness of breath, wheezing, tightness in chest, frequent respiratory infections, swelling in ankles, legs, etc.
Much of the treatment for COPD includes things that one can do to manage the disease on their own. However the medicines prescribed to treat COPD can be for long term duration as these help to prevent/relieve symptoms. If you are a patient of COPD, make sure you don't skip or discontinue medicines without consulting your doctor.
Inhalation therapy: principal mode of treatment in COPD, bronchodilator medicines which open up the airways are the mainstay of treatment, they are delivered by different type of devices like inhalers, dry powder inhalers or nebulization, which deliver drugs directly to the lungs. Patient education and use of correct inhalation technique is most important.
Oxygen therapy: patients with advanced COPD, have low oxygen levels in the blood, these patients require home oxygen therapy. Long term oxygen therapy (LTOT) is for patients who need to receive oxygen for 12 to 18 hrs a day lifelong. Oxygen can be delivered to the lungs via nasal prongs (tubes in nostrils), or face mask. Oxygen is supplied as compressed oxygen in metal cylinders, or as liquid oxygen or oxygen concentrators
Arterial blood gas (ABG) test- reveals the level of oxygen in your blood. Oxygen therapy can be given short term or long term. During respiratory infections, or flare up of COPD, short term oxygen may be needed which can be later discontinued..
Non Invasive ventilation- There is lack of awareness about non-invasive ventilation (NIV) treatment for COPD despite the fact that it reduces respiratory distress and risk of death considerably. A patient in moderate or advanced stages of COPD can be treated with an NIV machine/ BiPAP machine, which aids in bringing down the carbon dioxide level in the blood thereby enabling the patients to breathe normally.
Measures to Combat COPD
Because people with COPD or the ones who are susceptible to having respiratory diseases are recommended to stay indoors, it is important they improve their surroundings at home and take necessary precautions listed below:
- STOP SMOKING – smoking cessation is the main stay in management of COPD. Smoking in any form, bidi, hukkah, citrate or Vaping should be stopped. If difficult to leave do take help of your doctor.
- Stay Indoors: Stay away from smoke and air pollution. Even though you quit smoking, it's important to avoid places where others smoke because passive smoking can be equally harmful for the health of your lungs. As a cautionary measure you can avoid stepping out without wearing a mask.
- Invest in Right Mask: Make sure you buy mask which can filter pollutants in the air.
- Keep Your Indoors Smoke-Free: As a rule do not burn mosquito coils and incense sticks at home as the smoke/soot emitted from them can cause further breathing problems.
- Keep Hydrated: It is advisable to consume minimum 2 litre or more water in a day.
- Exercise: A little bit of exercise/yoga everyday will improve your respiratory muscles. Avoid strenuous exercises and discuss with your doctor to know which activities are safe for you.
- Have a Healthy Diet: It can help to boost your immunity and strength. Make sure you don't step out without having meals. Also, have fruits which are rich in antioxidants regularly.
(Dr (Brig) Sarvinder Singh is Senior Consultant – Pulmonology, Yatharth Super Specialty Hospital)