John Tiong Jeh Lung
MPharm, PhD, RPh
Did you know that chronic obstructive pulmonary disease (COPD) also known as chronic obstructive airway disease (COAD) is the fourth leading cause of death worldwide?
COPD accounts for 6% of all deaths globally with 90% of death cases being identified in developing countries. The global prevalence (total number of patients) of COPD is increasing particularly among those aged 30 years and above. It is also worth noting that COPD is more common among city folks compared with rural dwellers. More importantly, the progressive nature of the disease and the physical limitations imposed by the disease can significantly affect employability among urbanites.
What is COPD and what are the symptoms?
The hallmark of COPD is the persistent inflammation in the lungs which results in tissue damage. The process of thickening and scarring of the small airways is due to repeated injury and tissue repair. As the disease progresses, inflammatory response as well as airway remodelling (through tissue repair) will worsen, leading to progressive airway narrowing consequently causing airflow obstruction. This prevents air from effectively leaving the lungs. This damage to the lungs is associated with symptoms such as:
- Laboured breathing (dyspnoea)
- Persistent cough
- Increased in sputum (phlegm) production
The progressive decline in lung function may lead to episodes of disease flare known as exacerbations. The disease at its end-stage is characterized by:
- worsening dyspnoea even at rest
- lethargy
- weight loss
- insomnia
- anxiety
- depression
What are the common triggers for COPD?
The abnormal inflammatory response associated with COPD is commonly triggered by:
- Cigarette smoke including passive exposure (leading cause in high income nations)
- Biomass fuels for heating and cooking (leading cause in developing countries)
- Allergens/pollutants such as dust, pollen, mould, pet dander, smog, smoke from outdoor fire, cleaning products, paints,
- Viral and bacterial infections
Nevertheless, the risk of COPD development is a result of complex interaction between these external stimuli and genetic factors. The best documented genetic risk factor is a severe hereditary deficiency of alpha-1 antitrypsin (a known major inhibitor of serine proteases).
So what can I do if I have COPD?
The progression of COPD can be slowed by reducing the exposure to noxious stimuli. It is therefore important for you to learn and to avoid the triggers for COPD in order to prevent ‘flare-ups’. The following are some useful lifestyle advices:
- Avoid both active and passive smoking. Nicotine replacement therapy is recommended for smoking cessation.
- Turn on your kitchen hood or suction fan when cooking. Preferably, cook near a window.
- Stay indoor if there is an ongoing pollution outdoor. Turn on your air conditioner or use an air purifier.
- Avoid/minimize the exposure to household products which are known to trigger your condition.
- Practice good hygiene, get a pneumococcal shot as well as annual flu vaccination to prevent lung infections.
- Exercise regularly and get enough rest.
- Adhere to the prescribed treatment.
When should I go see a doctor?
Pay attention to your symptoms and seek immediate medical attention in any of the following events:
- Significant increase in intensity of symptoms
- Onset of new physical signs not experienced previously
- Frequent exacerbations
- Exacerbation not responding to the initial treatment (e.g. use of inhalers or nebulisers)
References
- Aaron SD., D.G., Whitmore GA., Hurst JR., Ramsay T., & Wedzicha JA., Time course and pattern of COPD exacerbation onset. Thorax, 2012. 67: p. 238-243.
- Adeolye A., C.A., Lee C., Basquill C., Papana A., Theodoratou E., Nair H., Gasevic D., Sridhar D., Campbell H., Chan KY., Sheikh A., Rudan I., & GHERG, Global and regional estimates of COPD prevalence: Systematic review and meta-analysis. Journal of Global Health, 2015. 5(2): p. 020415.
- Anthonisen NR., C.J., Murray RP., Smoking and lung function of Lung Health Study participants after 11 years. American Journal of Respiratory and Critical Care Medicine, 2002. 166(5): p. 675-679.
- GOLD, Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2016, Global Initiative for Chronic Obstructive Lung Disease.
- Lim S., L.D., Muttalife AR., Yunus F., Wongtime S., Lan LTT., Shetty V., Chu R., Zheng J., Perng D.,de Guia T., Impact of chronic obstructive pulmonary disease (COPD) in the Asia-Pacific region; the EPIC Asia population-based survey. Asia Pacific Family Medicine, 2015. 14(4).
- Stoller JK., A.L., Alpha1-antitrypsin deficiency. Lancet, 2005. 365(9478): p. 2225-2236.
- WHO. Chronic Obstructive Pulmonary Disease (COPD): Fact Sheet.
- WHO. Chronic respiratory diseases. Causes of COPD