Breathless
You leave me breathless,” so goes a line from a song. “You’re every thing good in my life, you leave me breathless.” But what if what leaves you breathless is not just the object of your affections? Taken in a less romantic sense, to be left breathless is not always a good thing. Breathlessness or a “need for air” is one of the most common symptoms of COPD or chronic obstructive pulmonary disease, an umbrella term used to describe chronic lung diseases that cause limitations in lung airflow. The airways become narrowed, which leads to a limitation of the flow of air to and from the lungs, causing shortness of breath. It is far more serious than just the shortness of breath you experience after climbing four flights of stairs. And it can cause something far worse than your common smoker’s cough. Unfortunately, COPD is an under-diagnosed, life-threatening lung disease that may progressively lead to death.
“All that wheeze is not asthma,” says Dr. Luisito Idolor, a consultant at the Lung Center. “The more familiar terms ‘chronic bronchitis’ (excessive sputum leading to chronic cough) and ‘emphysema’ (destruction of the lung tissue) are no longer used, but are now included within the COPD diagnosis. It is one of the most serious but least understood diseases. It is responsible for the deaths of over three million people a year worldwide, more than lung cancer and breast cancer combined. And while the incidence of cancer, heart disease, and stroke is going down, the incidence of COPD is going up. In 1990, it was ranked sixth among the leading causes of death. It is expected to rank third in 2010.”
Currently, COPD is the fourth leading cause of death globally. Locally, the Philippine Burden of Lung Disease (BOLD) study indicates that 12 percent or one out of eight individuals, 40 years and above living in Metro Manila, suffers from COPD, a figure that research says is much higher than earlier estimates.
The primary cause of COPD is tobacco smoke, including second-hand or passive exposure. The World Health Organization estimates that in 2005, 5.4 million died due to tobacco use, and tobacco-related deaths are projected to increase to 8.3 million deaths per year by 2030.
There is no dearth of messages about the negative effects of smoking on one’s health. The surgeon general’s warning has been more than subliminal. We’ve been told that cigarette smoking can lead to cancer. Well, here is one more — COPD. One more reason to think twice before starting on that second pack for the day.
A study that was conducted in Tondo, Manila showed the prevalence of COPD, particularly among smokers, with 83 percent among males, and 31 percent among females, 40 years old and above. In Nueva Ecija, a study in a rural area was conducted to determine the effect of exposure to biomass fuel. Indoor air pollution caused by smoke from home cooking and heating fuel is a risk factor, as well as outdoor air pollution, occupational dusts and chemicals such as vapors, irritants, and fumes.
In addition to the abnormal inflammatory response to noxious particles generated in the lung, with the severity of inflammation linked to the severity of the disease, some of the systemic manifestations of COPD include muscle weakness and weight loss. COPD is also associated with congestive heart failure. 30-40 percent have no symptoms. Only two percent are diagnosed by doctors.
A common lung function test called spirometry measures the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled by an individual. It is an important tool used to assess conditions such as asthma as well as COPD. COPD is irreversible and progressive.
“We want to be able to relieve the symptoms, improve the functional status of the patient, reduce mortality, and lengthen life,” asserts Dr. Lenora Fernandez, associate professor at UP-PGH. “The results, which studied more than 6,000 COPD patients, show that using Glaxo Smith Kline’s (GSK) fluticasone/salmeterol proprionate (the combination of inhaled steroids with long-acting beta-2-agonists or ICS-LABA) can slow the progression of COPD by significantly lowering the excess decline in lung function seen in patients with the disease by almost 30 percent, improving the patient’s quality of life during the same period.”
“Traditionally, early to moderate COPD is treated using bronchodilators,” Dr. Fernandez explains, “but given the presence of inflammation from early to late stages of the disease, anti-inflammatory treatment in the form of inhaled corticosteroids can be considered a treatment option even for COPD sufferers in the earlier stages. Combination therapy using ICS-LABA substantially reduces inflammatory cells, helping to slow the progression of the disease.”
“Quality of life is often severely affected by COPD, as patients frequently experience anxiety, hopelessness, and depression. In addition, fatigue, commonly aggravated by sleep disturbances and breathlessness, not only severely limits physical activity, but also impacts a patient’s economic and social well-being. Up to 75 percent of patients with COPD report difficulty in the simplest of everyday activities, such as being out of breath after climbing stairs,” Dr. Fernandez observes. “Improvement in the quality of life of COPD patients mark asignificant step forward in COPD treatment.” Wouldn’t it be nice if all that leaves you breathless is a vision of loveliness, and nothing else?
