HEALTH: A slow-motion death called chronic obstructive pulmonary disease

If you smoke heavily and for a long time, don’t just expect to suffer from lung cancer. You are also most likely to experience chronic obstructive pulmonary disease (COPD), another lung disease.

There are two main forms of COPD: emphysema (which involves damage to the lungs over time) and chronic bronchitis (which involves a long-term cough with mucus).

Thirty-year-old Jude A. (not his real name) used to be the center of attraction. He’s not only handsome but funny as well. In fact, he could be a movie star – if he wanted to be. In almost all parties, he was around and he never failed to attract the attention of everyone, including ladies. The only thing some friends didn’t like him was his habit of smoking.

Then, something went wrong. Lately, he frequently experienced a deep, chronic wet cough. When completing routine activities, such as climbing a flight of stairs, he comes short of breath. He also felt like choking with the smoke inside the disco houses he used to frequent.

“Your breathing is not normal,” the doctor told him when he went for a check-up one Friday morning. “After a thorough check-up and with your history of constant smoking, you have a chronic obstructive pulmonary disease.”

Jude was totally shocked and surprised. Shocked because he thought he wouldn’t have the disease. Surprised because he imagined only adults would suffer from COPD. Of course, he was totally wrong!

Every year, on the third Wednesday of November, organizers in more than 50 countries, including the Philippines, have carried out activities that would raise awareness and conduct education events on COPD. This year’s theme is: “Your Lungs for Life.”

Between five to six percent of Filipinos aged 30 and above suffer from moderate to severe COPD – and many of them remain undiagnosed. The reason is that the disease is relatively unheard of although it is common. “Awareness about COPD (in the Philippines) is relatively low,” points out Dr. Rafael R. Castillo, Philippine Daily Inquirer health columnist.

The Department of Pulmonary and Critical Care Medicine of the Philippine Heart Center (PHC) lists smoking as the number one cause of COPD. The Geneva-based World Health Organization (WHO) agrees. “Tobacco smoke, both through usage and second-hand smoke, is the main culprit,” the United Nations health agency points out.

Based on clinical research, cigarette smoking accounts for 80 to 90 percent of the risk for developing COPD. About 15 percent of all heavy long-time smokers develop the chronic disease.

In the Philippines, two of the famous men who died of COPD were television reporter Augurio Bautista Camu Jr. (better known as Jun Bautista in the media) and ace comedian Roldolfo Vera Quizon (Dolphy to most of his fans).

Even those constantly exposed to second-hand smoke over a 20-year period are also prone to the disease. “We’ve had couples, where it is the husband who smokes but the wife is the one who gets COPD,” said a doctor who is with the PHC pulmonary department.

COPD can also result from cigar and pipe smoking. In Singapore, for instance, 80 percent of people who suffer from COPD are heavy smokers. According to health experts, it is not the nicotine from cigarettes, cigars, and pipes that causes damage to the lungs, but instead, it’s the additives and the smoke.

Cigarette additives are numerous. “The additives and smoke can decrease lung function, directly damaging the lungs, decreasing important enzymes, and constricting lung vessels (bronchioles, alveoli, and capillaries),” explains the American Lung Association.

Other risk factors include occupational hazards, air pollution, heredity, a history of childhood respiratory infections, and second-hand smoke. “Second-hand smoke is more dangerous than smoking the cigarette itself,” says Dr. Encarnita Limpin, of the Philippine College of Physicians, adding that a large number of Filipinos acquired the disease through second-hand smoke.

There is also such a thing as third-hand smoke, which is even more lethal. As explained to GMA News Online by Dr. Imelda Mateo, chair of PCCP Tobacco and Air Pollution Council, it is the smoke from a lighted cigarette that combines with the nitric acid of the ambient air and settles on surfaces. “It stays there, it’s more permanent and more damaging than first- and second-hand smoke,” she was quoted as saying.

In 2004, some 64 million people worldwide were diagnosed with COPD, according to the UN health agency. In 2005, more than three million died of COPD, representing five percent of all the deaths in the world. By 2030, COPD will be the third leading cause of death around the world.

For every 1,000 Filipinos, 500 are males. Half of these men smoke, and within this group, around 16 suffer from COPD, reports Dr. Daniel Tan, a board member of the COPD Foundation of the Philippines.

“Sixteen out of every thousand may seem a small number, but computed from the country’s population, this means a staggering 1.28 million Filipino males are suffering from COPD,” wrote Dr. Tan in a Philippine Star feature. “In 20 years, COPD is projected to be one of the top diseases in developing countries like the Philippines.”

Shortness of breath, frequent morning cough – often called “smoker’s cough” – and increased sputum production are the initial symptoms. In more advanced stages, the disease can make a person dependent on oxygen to breathe, thus hampering his ability to perform normal daily activities.

“COPD affects men more often than women and is more often fatal in men, although there has been a recent increase in the rate of deaths in women,” says The Merck Manual of Medical Information.

Oftentimes, COPD is misdiagnosed as asthma since its initial symptoms include difficulty in breathing. But unlike asthma, which usually afflicts a person at a younger age, COPD develops typically among adults. Shortness of breath (dyspnea) upon exertion is also more common in COPD patients than those with asthma.

COPD symptoms also tend to worsen with age while asthma symptoms are typically more episodic and stable over time. COPD can also lead to cardiac complications, while asthma does not. There is also a more direct link between smoking and COPD rather than smoking and asthma.

According to the Mayo Clinic, COPD can cause many complications, including: respiratory infections, heart problems (including heart attack), lung cancer, high blood pressure in lung arteries, and depression. “About 30 percent of people with more severe airway obstruction die in one year; 95 percent die in 10 years,” the Merck manual informs.

“The most devastating consequence of COPD is the incapacitation of the patient during the most productive years of his life,” Dr. Tan said. “It destroys his ability to earn a living and disrupts the lives of his family members for as long as 20 years before death occurs.”

There is no known cure for COPD yet. However, it is controllable. Therefore, its diagnosis is important, so that the correct interventions can be made. These will not treat the disease, but will slow down its progress.

“Although COPD is considered a very preventable disease, effective treatments for relief of breathlessness do exist in the form of bronchodilators like beta-agonist, anticholinergic, and xanthine drugs,” Dr. Tan said. “Early diagnosis is considered critical in the prolongation and the improvement in the quality of life of these patients.”

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