Chronic Obstructive Pulmonary Disease (COPD) – An Indian Scenario

COPD is a disabling disease for the patient and for those who care for the patients. It still has not received enough attention from the public or authorities. There are a lot of government bodies and NGOs to help cancer and renal patients, but COPD patients receive no attention, and a lot of them are suffering more than a cancer patient. The lack of attention may be partially due to its link to smoking, so that the patient is blamed for his disease. According to estimates in the Global Burden of Disease Study (GBDS), COPD may become the third highest cause of death and the fifth highest factor in the loss of DALYs (Disability Adjusted Life Years). (1, 2, 3)

Prevalence

Tobacco-backgroundThere are very few studies in India regarding prevalence of COPD, but the ones available show a wide range from 3 to 7 percent, and it is also the fourth leading cause of death in men. The prevalence in women is about 3.5%, which is mainly due to exposure to passive smoking and indoor pollution secondary to biomass fuel use for cooking and heating. (4, 5)

Diagnosis

The diagnosis of COPD is mainly clinical. X-rays show hyperinflation in advanced cases, however, the use of pulmonary function tests (PFT) is gaining momentum. (6, 7) A PFT provides objective evidence and a tool to monitor the disease over the years. It also helps us to differentiate asthma with reversible airflow limitation from COPD, and a normal PFT will help us to think of alternative diagnostic possibilities like cardiac problems and pulmonary embolism.

Treatment

All patients with newly detected COPD should be encouraged to stop smoking and should be given treatment for it, if required. Generally followed treatment is based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Inhaled steroids help to reduce exacerbations and hospital admissions. Inhaled Tiotropium has long term benefits, but with side effects related to dryness of secretions. Inhaled bronchodilators give partial response as expected. Theophyllines are not used much in developed countries but are extensively used in our country (7).

Managing exacerbations is an important issue in overall care of a COPD patient. IV antibiotics, parenteral steroids, nebulisation and oxygen are used commonly. Non-Invasive Ventilation (NIV) plays an important role where facilities are available. Even though ICU care is appropriate, intubation and ventilation may not be appropriate in all cases. An assessment of the pre-morbid condition should be done on all patients: someone who has gone to market on his own just before the event will be a good candidate, but a person who just walks from bed to bathroom is not. However a general consensus should be made in discussion with ...

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