CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality in the 21^st century. The Global Burden of Disease Study by the World Health Organization projected that COPD will become the third leading cause of death worldwide by 2020. ⁽¹⁾

In the Philippines, it ranks as the 7^th leading cause of death with a prevalence rate of 13.8% in Manila. ^(2,3) Despite the high incidence of COPD in the Philippines, only 2% of the cases are diagnosed by doctors in contrast to the overall prevalence. ⁽⁴⁾ The cause of this under-diagnosis and under-treatment is probably due to lack of public health awareness of COPD in our country.

COPD is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lungs. Cigarette smoking continues to be identified as the most commonly encountered risk factor, accounting for 80-90% of cases. ^(6,7) Other risk factors that should be taken into account include air pollution,  exposure to certain dust, chemicals in the workplace, indoor air pollution from biomass cooking (i.e. firewood/charcoal), and heating in poorly ventilated dwellings. Only a few cases of COPD are caused by genetic condition.

A clinical diagnosis should be considered in any person 40 years old and above who has risk factors such as exposure to noxious particles or gases.  A COPD patient may not feel anything at the start and develop cough and sputum production during the mid to late stage of the disease.  Thus, high index of suspicion is needed for any person with risk factors. Spirometry is needed to make a confident diagnosis of COPD. It is one of the diagnostic tools that is often underutilized in the Philippines.  A person with risk factors and symptoms should ask his/her doctor about spirometry testing.

The impact of COPD is not only confined to its ill effects on the individual’s health but may also result in an economic and social burden that is both extensive and increasing. ^(6,7) There is a direct relationship between the severity of COPD and the cost of care.  In developing countries like the Philippines, COPD will certainly force two individuals to give up their work - the person afflicted with COPD and a family member who must now stay home to care for the sick individual. Given that people are often the most vital asset for developing nations, the indirect costs of COPD potentially pose a serious threat to their economies.

Appropriate pharmacologic and non-pharmacologic interventions are needed to reduce the symptoms, frequency and severity of exacerbations and improve health status and exercise tolerance. Smoking cessation is without doubt still the single most effective way of reducing the risk of developing COPD and delaying its progression.

It is important to remember that for COPD patients, early detection of the disease and appropriate interventions are vital.  These can help slow down its advance and facilitate quality of life for the patient.  To quote 2014 World COPD Day’s theme:  IT’S NEVER TOO LATE…