Chronic obstructive pulmonary disease (commonly referred to as COPD) is a lung disease that affects the flow of air from the lungs. COPD comprises two conditions; chronic bronchitis and emphysema. However, the two conditions have increasingly been diagnosed just as COPD. The limitation in the low of air is due to the narrowing of airways and collection of mucus (chronic bronchitis) and/or the loss of the elasticity of the airways, which affects the narrowing and widening of the airways during exhalation and inhalation. This disease has been colloquially referred to as ‘smokers cough’ due to its relation to smoking, which remains its commonest cause. COPD is not curable, but it is preventable.
The incidence of COPD has been increasing over the years, and unlike the past when the disease manly affected men, it now affects both men and women alike. This has been linked to the higher number of women who smoke. As at 2008, it was estimated that up to 18% and 0.7% of men and women respectively in Kenya smoke (WHO, 2010). Undoubtedly, this number has increased. Though tobacco smoke remains the primary risk factor, there are other risk factors such as air pollution such as seen with wood smoke when cooking or heating, some type of industrial dusts and chemicals.
COPD symptoms include a chronic cough with production of sputum which is usually worse in the morning, breathlessness and wheezing in some cases. This difficulty breathing gets worse with time and with exertion such as climbing stairs. COPD progresses gradually over time, getting worse as one grows older. Therefore most cases are diagnosed in people over 40 years. The diagnosis is based on determining the flow of air in and out of the lungs, which is done through a test called spirometry. The less the amount of air exhaled after inspiration, the more severe the disease. Other tests may then be conducted such as chest x-ray, arterial blood gas, chest CT scan etc.
Once the diagnosis of COPD is made, the most important step in treatment is to STOP SMOKING. This, together with other treatment options slows the progression of the disease. As mentioned above, COPD is not curable, but there are medications that can ease the symptoms. The most common medications used help dilate the airways to allow for improved movement of air in and out of the lungs, and may be taken orally or in the form of an inhaler. In severe cases, the use of steroids and oxygen may be necessary. COPD tends to have periods of acute episodes, where symptoms worsen for a short period commonly due to infections. When this occurs, patients need to seek medical attention immediately. Due to this susceptibility to frequent infections, most COPD patients are advised to routinely receive the influenza vaccine.
One of the most difficult challenges that COPD patients face is how to quit smoking. As most smokers will confess, this is easier said than done. Nicotine which is found in cigarettes is the addictive ingredient which causes withdrawal symptoms once one stops smoking. These withdrawal symptoms include anxiety, irritability, fatigue, lack of concentration, lack of sleep or drowsiness. These symptoms can be very unpleasant, leading to the frequent relapses. There are various tools that smokers can use to help quit smoking. These include:
- Setting a quit date – this is a crucial first step in the efforts to stop smoking. It helps one prepare psychologically to stop, and to deal with the after effects. The involvement of the doctor in setting this date is important since the period prior to stopping includes education of the patient on what to expect.
- Support both personal from friends and family, and professional through individual or group counseling.
- Nicotine replacement to reduce the withdrawal symptoms have been used successfully in those highly addicted to nicotine. Nicotine replacement is often through nicotine chewing gum and nicotine patches, which are readily available in the market.
- Antidepressant – in some cases, a specific antidepressant may be prescribed.
COPD is a life threatening incurable lifestyle disease, and can be largely prevented by smoking cessation, and the earlier this is done, the better.