Time to butt out

Chronic Obstructive Pulmonary Disease (COPD) – the rather technical term for lung disease, may not be known well enough to strike terror, but it should. COPD affects millions each year and exposure to cigarette and bidi smoke has been established to be the main cause. India, it is estimated, will account for 18 per cent of the 8.4 million global tobacco-related deaths by 2020, and a large proportion of these are likely to be COPD-related.
COPD kills more people than HIV-AIDS, malaria and tuberculosis put together in southeast Asia. The prevalence rate in India varies from 2 to 22 per cent in men and 1.2 to 19 per cent in women, says Dr. Lancelot Pinto, consultant respirologist and smoking cessation therapy specialist at Mumbai's PD Hinduja Hospital. A recent study covering healthy individuals undergoing routine health check-ups at the hospital found the prevalence of COPD to be 12 per cent. "These were individuals unaware of the fact that they had COPD, so the actual proportion of patients with the disease is likely to be higher."
Dr Preyas Vaidya, pulmonologist at Mumbai's Fortis Hospital, adds that smoking bidis and cigarettes, as well as passive smoking among nonsmokers, are risk factors that stood out in a 2012 cross-India study.

Connect and prevalence
"Toxins present in cigarette smoke damage the elasticity of the lungs and cause narrowing of the air passages. This damage can be progressive, that is, it continues even after a person stops smoking. However, the rate of damage and the loss of lung function slow down significantly once an individual stops smoking," says Dr Pinto.
A global adult tobacco survey estimated that 14 per cent of Indians are current smokers. Besides, India is the second largest consumer of tobacco products and the third largest producer of tobacco in the world, making it a potential hotbed for a COPD epidemic.
"COPD usually occurs after 35-40 years. Males are reported to have a higher prevalence than females," says Vaidya. "But there are now indications of a rising trend of smoking among women, quite possibly as a consequence of social factors like increasing financial independence among women, and the targeting of women by the tobacco industry," adds Dr Pinto. The strong association between the use of biomass fuels (cooking on a wood stove, chulha, sigri) and COPD also puts women at risk.

Look out for...
"Shortness of breath, initially on physical exertion, gradually progressing to shortness of breath on doing daily activities, such as having a bath that further progresses to shortness of breath at rest, is the normal pattern of untreated COPD," says Dr. Pinto. "Other symptoms are a cough that is present for a few months every year, cough with phlegm, especially in the morning (often dismissed as 'smoker's cough'), and repeated episodes of cough and fever needing visits to the doctor." Some people, adds Dr Vaidya, may experience fatigue. "With increased severity, weight loss and leg swelling may be noticed. A change in the nature of the usual cough for smokers is an important clue/indicator of COPD."

There's hope
Treatment options for COPD include inhaled bronchodilators, inhaled steroids, oral bronchodilators and drugs.
Dr Pinto cites the case of a 70-year-old businessman to illustrate how effective it can all be. The patient, who came to him in May 2014, had been a smoker for years and had severe COPD with shortness of breath getting progressively worse. He had almost accepted the fact that he would have to live a restricted life. But a year on, interventions such as optimisation of medicines and inhalers, learning the right way to take inhalers and breathing techniques, education about the nature of the disease, screening for depression and anxiety, vaccination against influenza and pneumonia and a pulmonary rehabilitation programme have made a dramatic difference. Today, his quality of life is far better and he is managing his COPD well. There's more good news coming in. "Pulmonary rehabilitation centres are emerging for COPD, newer, longer acting bronchodilators are in the pipeline and will soon be introduced in India and vaccinations are now available for COPD which decrease the risk of infections and help reduce hospitalisations," says Dr Vaidya.
"However, the most significant impact on the future of the disease is likely to be a result of interventions that help individuals quit smoking, and, in developing nations, a reduction in the use of biomass fuels and levels of pollution. These include newer drugs and the use of nicotine replacement therapy," asserts Dr Pinto.
Clearly, while medicines have their place, giving up tobacco is your best option to keep COPD at bay.