COPD: tobacco smoking main cause in men, exposure to biomass smoke in women
COPD Day is commemorated all over the world on November 14. World COPD Day is an annual event organised by the Global Initiative for Chronic Obstructive Lung Diseases to improve awareness and care of COPD patients worldwide. This year’s theme is ‘It’s not too late".
For people with symptoms who have not been diagnosed its not too late to ask your doctor for a lung function test, for patients with COPD its not too late to live an active life and for doctors who care for people with COPD its not too late to help patients breathe better.
Chronic Obstructive Pulmonary Disease (COPD) causes obstruction to tubes (bronchi) which carry air to the lungs and destructs lung parenchyma which supplies oxygen to the body. This leads to chronic cough with sputum production and breathlessness. Currently COPD is the 4th commonest cause of death and according to the World Bank Global Predictions COPD is predicted to be the third commonest cause of death by 2020. This reality is alarming and the WHO is promoting preventive measures to control this non communicable disease. You cannot get COPD from someone else so it is worth knowing what causes COPD.
The risk factors for COPD are tobacco smoking, biomass smoke exposure (indoor smoke pollution caused by burning wood, dried dung, leaves and crop residue), environmental pollution and air pollution at workplace due to exposure to dust and fumes.
Tobacco smoking is the most important risk factor for COPD in developed countries. In a country like India where the prevalence of smoking is low in women (3.6 per cent), the prevalence of COPD in women is same as men. The risk factor for women having COPD is exposure to biomass fuel smoke. The awareness that biomass smoke causes COPD is low among physicians and general public.
COPD is insidious with a long latency period before clinical recognition and is mostly overlooked by patient. As the manifestation occurs after 40 years of age, it is attributed to the ageing process or just "smokers cough" by the patient. 80 per cent of smokers neglect this early sign of COPD. As the disease progresses so does breathlessness and patient first reduces work or changes to a lighter job and finally quits his job due to severe breathlessness leading to loss of wages. Recent studies have reported that 30 per cent of smokers are developing the disease. A study conducted at the Department of Pulmonary Medicine at the Goa Medical College showed that 57.5 per cent of men and 42.5 per cent of women had COPD. Tobacco smoking was the main cause of COPD in men and exposure to biomass smoke was the cause of COPD in women. More than 50 per cent had severe disease leading to poor quality of life.
COPD causes a huge economic burden to the patient and the state, but it does not receive much attention as it does not kill suddenly as myocardial infarction (heart attack). The Global Status Report on Non Communicable Diseases (NCDs), 2010 by WHO states that for every 10 per cent rise in NCDs there is 0.5 per cent reduction in rates of annual economic growth and a 2 per cent reduction in NCDs death is estimated to increase economic growth by 1 per cent per year.
We have to strive to reduce the burden of COPD. This includes stopping smoking by creating awareness about its ill effects, ensuring availability of cleaner fuels for domestic cooking and heating and cleaner air at place of work. Finally we also need to create awareness to detect and manage the disease early so that the patient can have a better quality of life.
(The writer is a consultant chest physician at department of Pulmonary Medicine in Goa Medical College) [NT]