COPD, an abbreviation for Chronic Obstructive Pulmonary Disease might sound as an odd name to most of the readers of this article. Yet it is a very common and important disease as can be guessed from the fact that November 17 is used internationally as the World Awareness Day for COPD. In lay terminology in India, COPD is categorized as `dama’ or asthma, although it is entirely different from asthma with which people are generally more familiar. The common factors in both the diseases are the presence of obstruction to the airflow in the lungs and the symptoms of breathlessness, cough or wheezing (etc.)
Asthma is a common allergic problem which starts from childhood, responds to drug administration and presents a waxing and waning course. On the other hand, COPD is almost exclusively a problem of chronic smokers, starts in thirties or later and relentlessly progresses with time. COPD is now recognized as a major course of global morbidity and an important economic burden on health care infrastructure. According to our own published work, there are about 5 percent of male and 2.7 percent of female adults of over 30 years of age who suffer from COPD in India. This is likely to account for a total number of over 18 million (i.e. 1.8 crore) patients. This is an enormous health burden especially when one considers the facts that most of these patients are the primary bread earners in their families and the disease is progressive and disabling – a cause of premature respiratory crippling and death. In economic terms we have estimated through our ICMR sponsored study that a COPD patient on an average spends about one third of his monthly income on disease management. This is in addition to the costs borne by the state on subsidized health care services.
Unlike many other disease where the onslaught on health is acute and sudden, COPD is slow and insidious in onset, remains unrecognized or missed as smoker’s cough for long periods of time, but keeps progressing. Ultimately, it leads to irreversible respiratory failure and its consequences thereof. Primarily it presents with chronic cough especially in the winters and/or breathlessness on exertion. In later stages, the patient may find it hard to perform even the routine daily activities and soon get confined to the bed. Frequently, the disease is complicated with episodes of respiratory infections, each such episode causes worsening of symptoms, destabilization and deterioration of lung functions.
Tobacco smoking is the single most identifiable case of COPD. Therefore tobacco cessation is the mainstay of managing this problem. Quitting smoking would result in at least some degree of reversal of disease symptoms and severity at all stages and prevent further progression. In most instances, one can label COPD as a preventable disorder provided one can take care of the smoking habit.
Symptomatic relief from COPD is obtained by use of different kinds of drugs which cause dilatation of the air tubes and reduce inflammation. These drugs are generally available as inhalers. Standardized Global Guidelines for Management of Chronic Obstructive Lung Disease called GOLD are now used the world over. In India, we had formulated guidelines adapted to the primary and the secondary levels of health care under the Government of India – WHO Biennium Programme 2002. These guidelines are new considered as the standard of care in field conditions in India.
As stated earlier, a patient of COPD generally carries the entire family load and responsibilities on his shoulders. The disease stabilization and rehabilitation are therefore very important issues. Besides smoking cessation and drug therapy, the other steps include long term administration of oxygen at home, exercise conditioning and psychosocial supports. A comprehensive domiciliary disease management plan is the next step which requires to be undertaken rather aggressively. It is high time that such programmes and activities are made widely available in this country as well.