When our King of Comedy died from chronic obstructive pulmonary diseases or COPD, it was no laughing matter. This disease had not received as much limelight as heart attacks as the deaths that result from them are not as sudden and dramatic. It is important to note however that it is the third leading cause of death worldwide.
COPD results from the exposure of the lungs and the air passages to harmful stimuli, most notably smoking, resulting in damage that may have limited reversibility. The airways passages narrow and the lungs remain inflated, resulting in difficulties in exhaling the air from inside the lungs. This increases the work of breathing resulting in shortness of breath.
Early on, COPD may be asymptomatic and our only clue may be a history of smoking or, in some cases, cooking using firewood. It is unfortunate that once a patient has symptoms, this usually means that the disease is moderately advanced. Furthermore, as the disease occurs after the age of 40, the shortness of breath is attributed to aging and the cough to smoking. It is therefore important to do early testing of lung function, and this is called spirometry. This will be able to detect airway obstruction and determine the severity and its reversibility.
Once a patient has been diagnosed, it is important to prevent a more rapid deterioration in lung function. Key to this is immediate smoking cessation and removal of all toxic exposures. Vaccinations for flu and pneumonia will likewise provide added benefit. As the symptoms are often debilitating enough, they cause deconditioning because of the activity limitation that COPD imposes. Pulmonary rehabilitation programs are available to help patients cope with this and return them to some degree of functionality.
In terms of medications, inhaled medications present the best options as these are deposited directly into the airways and lungs where they are needed and the doses are administered in smaller amounts, thereby minimizing side effects that would be magnified and noticeable if they were administered orally.
Using the international guidelines called GOLD, a patient is classified according to a subtype, depending on his or her lung function, the capacity for physical activity and the number of times the disease has caused an emergency room visit or hospitalization. Based on the classification, the patient may be started on as needed inhalers with short-acting medications that provide rapid relief or maintained on long-acting drugs that provide sustained assistance.
In our country, the association of lung specialists called the Philippine College of Chest Physicians has embarked on a national strategy to combat this very preventable disease. It’s never too late to stop bad habits and start the journey to a better life!
Dr. Patrick Gerard Moral is vice president of the Philippine College of Chest Physicians and head of training committee of the Center for Respiratory Medicine, University of Santo Tomas Hospital. The A to Z of Health Information Advocacy is a joint initiative of a group of medical specialists and supported by AstraZeneca Philippines aimed at raising public awareness on various diseases and providing health information and updates to the healthcare community.