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COPD – a lethal but preventable disease

CHENNAI: Chronic Obstructive Pulmonary Disease (COPD) is a common respiratory disease, which produces cough and breathlessness. The cough often produces phlegm, which turns yellowish or greenish when it gets infected.

In western and wealthier countries, the disease is almost entirely attributed to smoking. In India and other developing countries, factors such as air pollution, both indoor and outdoor, play a larger causative role.

Cigarette smoke and polluted air cause inflammation of the airways in the lungs, which in turn leads to excess mucus production and narrowing of the airways causing the well-known symptoms. The lung function gets progressively reduced leading to worsening of breathlessness, and finally to respiratory failure and death.

Treatment options are improving and mainly consist of bronchodilating medication given by inhalation. Though new drugs are being developed, no available drug has consistently shown any effect in improving lung function or reducing the number of deaths.

COPD affects approximately 5 per cent of adults in India. It is more common among men than women. It is difficult to assess its prevalence accurately as the symptoms are common to other well-known diseases such as asthma and TB. Lung function tests such as spirometry, which help in diagnosis, are not widely available.

Surveys such as the one done by the Indian Council of Medical Research in 2006 among residents of Chandigarh, Delhi, Bangalore and Kanpur may, therefore, be an underestimation. Moreover, the prevalence is increasing, largely due to an increase in smoking and air pollution in rapidly industrialising societies. Its incidence was expected to double in the world between 1990 and 2020, according to the Global Initiative for Obstructive Lung Disease (GOLD). By 2020, COPD is expected to become the third major cause of death. The cost of COPD to the country as well as to the individual is enormous. The U.S. health care system spent $24 billion for this disease alone in 2002. Costs in regard to India are not known. In addition to the direct costs of medical treatment, indirect costs such as absenteeism have to be considered.

A study revealed that some men spent up to 45 per cent of their income on tobacco products and treatment for diseases caused by them. Due to the relatively low benefit-to-cost ratio of medication for COPD, the most appropriate strategy for large countries with limited resources such as India would be to concentrate on prevention.

Preventing youngsters from taking to smoking would appear to be the most effective.

The government has done well in enacting the Tobacco Control Act of 2003, which prohibits smoking in public places and advertising and selling of tobacco products to minors. Implementing this Act needs improvement.

Large markets such as India and China have been targeted by cigarette companies to compensate for declining sales in the developed countries. We need to take concerted action to prevent large sections of the population succumbing to the scourge of tobacco.

We also need to address the issue of outdoor pollution by appropriate clean air acts and that of indoor pollution by providing alternative cooking and heating fuels at reasonable cost.

(Dr. Raj B. Singh is Managing Trustee, Chest Foundation of India.)

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