“COPD: THE TERROR OF THE 21st CENTUARY”


Dr Virendra Singh
Professor, Head,
Division of Allergy &
Pulmonary Medicine
SMS Hospital, Jaipur
Hon. Research Advisor:
Asthma Bhawan,
Vidyadhar Nagar, Jaipur


(In majority of patients, COPD is caused by preventable causes e.g. exposure to tobacco smoke - active or passive, biomass fuel & air pollution. Although till date, it is not a curable disease but with modern treatment patient's sufferings can be significantly reduced & he can lead a near normal productive life. For achieving these goals awareness about disease is important, and in this article author has made sincere efforts in an impressive way through his long experience.

Editor)       

Is asthma and COPD the same disease?

Both the diseases are known as ‘dama’ in hindi language therefore many people believe them one disease, which is a misconception. The only similarity in these diseases is that both are respiratory disorders and involve lung. Both diseases differ in age, cause, severity of illness and in prognosis. About 30 million people in India are suffering from asthma while numbers of patient of COPD may be even more.
The difference between asthma and COPD have been shown in the table-

  Asthma COPD
Starting Age Childhood Older age (>40 years)
Allergic aggravating factors Dust, pollen grain, pet animals, fungus No allergic aggravating factors
Other causes Smoke, cold, throat infection, irritating smell Cold, viral infections and pollution
Time of difficult breathing In night during sleep or in morning After exertion
Other associated symptoms or disease Sneezing, itching in eyes, running nose and urticaria Heart disease, thin bones
Causes Runs in family. Mother, father, brother or sister may be suffering from allergic disease Smoking, tobacco consuming, living in polluted air

Is COPD a new disease?

COPD is not a new disease and known in general public by different names such as bronchitis, emphysema, dama etc. World health organization (WHO ended this confusion caused by different names and has kept these diseases under the category of COPD and decided to celebrate 17th November, 2004 as COPD day.
Full name of COPD is: Chronic Obstructive Pulmonary Disease
C: Chronic- long lasting disease
O: Obstructive- blocking of airways
P: Pulmonary- of lungs
D: Disease- illness

Is COPD a dangerous disease?


Mortality data suggests that in Indian villages COPD is the major cause of death. According to central home ministry mortality data, COPD is responsible for mortality in 12% Indian villagers while heart attack causes 8% mortality. According to WHO (2000) the deaths due to CPOD in India are much more than the death due to cancer, diabetes, heart attack and paralysis. COPD is the 6th major cause of mortality in whole world but by 2020 it may become the 3rd major cause of mortality. COPD is not only fatal but is also a big cause of human pain. Person suffering from severe COPD is unable to walk even few steps. Sometimes daily routine activities such as bathing, going to toilet and combing hair may cause great difficulty in breathing. Such patients have to spend their life in the bed only. In severe COPD sitting, changing posture and coughing also cause unbearable pain. In this situation the breathing difficulty frustrates and induces depression.

Is COPD a communicable disease?


It is not a communicable disease. COPD cannot spread from one person to another by any type of contact. Eating, sleeping, talking does not spread COPD from one person to another.

Who are affected by COPD?


Fresh air is most essential for life. God is kind enough to give us fresh air in sufficient amount and that too free of cost. Unfortunately many of us do not realize its importance and adulterate the breathing air by smoking and pollution. Adulterated smoky air enters in the respiratory tract and lungs to cause COPD in 2-3 decades. COPD normally occurs after 40 years of age. It does not occur in children.

What are causes of COPD?


Smoking related air pollution is injurious to lungs. 80% patients of COPD are smokers. 20% COPD patients do not smoke but are still suffering because they live in polluted air. Among them women making food in wood & upla chulhas, workers of smoke releasing industries, and workers in contact with pollution caused by vehicles.

Does smoking causes cancer or COPD?


Smoking causes many diseases and cancer and COPD are important fatal diseases caused by smoking. In the following table various causes of death due to tobacco related diseases are given. It is evident that COPD is most common mode of death in smokers.

Tobacco induced disease In Million Percent
COPD 1.25 23%
Cancer 1.00 18%
Heart disease (CAD) 0.85 15%
Paralysis (CVA) 0.45 8%
Lung infections 0.20 4%
TB 0.15 3%
Other tobacco related diseases 1.60 29%
  5.5 (Million) 100%

Source: WHO report on the global tobacco epidemic, 2008 MPOWER. [online available from www.who.int/tobacco/mpower. [Accessed in May2010].

What are symptoms of COPD?


- Expectoration for long time
- Cough
- Cough specially during winter months
- Difficulty in breathing especially during exertion
When a smoker develops any of these symptoms repeatedly, it may indicate onset of COPD.

Is X-ray diagnostic of COPD?


X-ray is generally normal in initial stages of COPD. When X ray chest is normal many persons think they are normal. It is a misconception. COPD is diagnosed by a breathing test called spirometry. It makes diagnosis of COPD and measures its severity. Unfortunately awareness about this test is very low among common people. Therefore many times diagnosis of COPD is made in late stages and in advanced state.

Is COPD incurable?


DAMA goes with DAM (Life). Both the patient and doctor believe that once a patient suffers from dama, he has to live in agony through out his life. It is true that COPD cannot be cured completely in majority of patients. But this is also true that on taking proper treatment all the patient can get rid of symptoms and can live a good life. Newer medicines and treatment modalities can reduce agony of respiratory distress considerably. If we compare with other diseases the benefit obtained by treatment in COPD is almost comparable to that obtained in like hypertension, heart disease, rheumatoid arthritis and diabetes.

Does severity of COPD increases with time?


When COPD starts cough and sputum are the only symptoms of COPD. Normally a smoker considers symptoms of cough and sputum a normal phenomenon and therefore does not consult a doctor and continues smoking. Usually difficulty in breathing starts when his lung functions are reduced by more than 50% of the normal. Breathlessness indicates shift of COPD patient from mild to severe stage. Those who do not stop smoking even after having COPD in them, lungs are further damaged slowly and COPD becomes more & more severe. In advanced state of COPD level of blood oxygen (O2) decreases and that of carbon oxide (CO2) increases. It indicates severe condition of COPD called respiratory failure. In such situation a patient feels exhausted even on walking a few steps. Such patients are not able to do even the routine activities like bathing and brushing.
Further decrease of O2 supply to the body makes the patient to struggle for life. The energy spent in breathing by a severe COPD patient in sitting position is equal to the energy spent by a normal person during running. Loss of calories or energy leads to reduction in weight and therefore many patients of severe COPD are reduced to skeleton only.
If a COPD patient decides to stop smoking the progression rate of severity of COPD is reduced but the disease still persists.

How many years of smoking cause COPD?


Exact period of smoking to cause COPD is not certain. In majority of people it starts after smoking for more 15-20 years. Lungs are very strong organs and they are capable of bearing the brunt of smoking for 15-20 years without acquiring the disease. Excessive sputum formation is the only complaint in initial stages of COPD patients. In the later years frequent cold and cough appears. Breathlessness on doing heavy work is usually a late symptom.

Can we prevent severe condition of COPD?


If we can diagnose COPD in initial stages then we can prevent its progression towards a severe stage. Unfortunately in India in majority of patients we come to know about the disease only when it has reached its severe stage.

What is exacerbation of COPD?


During climatic changes cough and cold caused by viral infections are commonly observed even in normal persons. It subsides within 3-5 days and the patient become free of the disease. However, in COPD patient simple cough and cold sometimes cause severe worsening of the disease called exacerbation of COPD. In many patients acute exacerbation of disease leads to respiratory failure. Very severe exacerbation may cause severe distress and death.

Why are we unable to diagnose COPD in its early stage in India?


Sputum formation is the key complaint in COPD patients during early stage. People who are smoking do not consider the sputum formation as a disease. In villages where COPD is a serious disease, sputum formation or cough problems are masked in routine life. In villages the purdah system is present since years. Whenever an elderly man enters the house then he coughs loudly so that the females of that house can use their purdah. Loud cough results in swallowing of sputum in the stomach inadvertently. Therefore the man is not aware of problem of excessive sputum. Houses of a village are not provided with wash basin and therefore spitting is not considered good. In such a situation women usually swallow the cough induced sputum instead of spitting. She remains unaware of her problem of excessive sputum. Therefore early stage of the disease remains undetected. The patients continue smoking or remain exposed to pollution and the severity of COPD keeps on increasing.

What are treatment options for a COPD patient in early stage?


In order to curb the COPD in any stage the most important step is to stop smoking or to stop inhaling polluted air. Once smoking is stopped, the condition of lung will improve.
Regular exercise and healthy diet like fruits, proteins and green leafy vegetables play an important role in healing of disease

What is the treatment of COPD in severe stage of disease?


The objectives of treatment in severe stage of the disease are as follows: a. Stop progression of the disease: Smokers should stop smoking completely. In such condition even a single bidi or hukka per day is dangerous. b. Relief of symptoms: Medicines should be taken regularly. Now we have many effective medicines in inhaled form available in the market. These medicines are capable of providing relief in the symptoms. c. Improvement in working capacity: Proper exercises in respiratory rehabilitation programme were found useful in improving physical capacity of severe COPD patients. Our study published in Indian Journal of Chest disease has shown that these exercises if performed regularly can improve the walking distance even in severe stage of the disease. d. Prevention of COPD exacerbation: In order to prevent exacerbation of COPD a patient with COPD should be cautious about following points specifically during winters months- - Keep away from people suffering from cold and cough - Proper protection from cold by wearing woolen cloths - While travelling on scooter or in cold, use high neck cloth so as to cover the neck - Wear warm socks in foot. - Avoid taking bath in open - Take hot water bath in winter - Women should dry their hair with a drier after hair wash - Avoid sitting outside the house for long time after sunset - Avoid getting wet in the rains - If cold occurs then consult a doctor for antibiotic treatment - Use vaccine for influenza infection e. Avoid taking the following medicines Some medicines can make COPD worse therefore these should be avoided. Propranolol a medicine given to control blood pressure should be avoided in COPD patients. In severe stage of COPD patients there is decrease in O2 while increase in CO2 which results in restlessness, giddiness and sleeplessness. In such a condition sleeping pills may prove fatal and therefore should be avoided.

What are treatment options for a COPD patient in respiratory failure?


In severe stage of COPD there is lack of O2 in blood it is called respiratory failure. Amongst these patients few have normal CO2, these patient can get relief by taking O2 at their home. O2 can be taken by a cylinder or by an O2 concentrator. In big cities O2 companies take Rs.2000-3000 as security and provide the big O2 cylinder. These companies also fill the cylinder at home in Rs.200-300. O2 concentrator is other option available in market. This is a machine which extracts O2 from air and provides it to the patient. Although it comes in Rs.50, 000 -70,000 but for consuming O2 in long run it would be cheaper.
Another group of COPD patients suffering from respiratory failure have decrease in O2 and increase in CO2 level in blood. In such cases if only O2 is given then symptomsinstead of improving will deteriorate further. For these types of patient Bipap machine is helpful. This is a ventilator machine which can be used at home. This machine not only increases the O2 level in the body but also decreases the CO2 level.

What are danger signals of COPD?


Whenever a COPD patient experience following symptoms in spite of taking regular medication he should quickly seek the doctor’s advice.
• Presence of cough and cough
• Increase in sputum production
• Yellowish-green discoloration of sputum
• Giddiness, restlessness, sleeplessness
• Presence of fever
• Increase in respiratory rate
• Increase in breathlessness on walking
• Increase in sleeplessness or drowsiness

Dr Virendra Singh