Lung attack, a dangerous episode caused by chronic obstructive pulmonary disease (COPD), is increasing worldwide.
COPD may be the fifth leading cause of death in the world by 2020, and is estimated to quickly escalate as the third leading cause of mortality by 2030, according to the World Health Organisation.
While not everyone is yet as familiar with lung attacks as they are with its coronary counterpart, between 5 and 20 per cent die within a year after the initial attack. It is also currently the third leading cause of death in the United States, according to a report by the Centers for Disease Control and Prevention.
Lung attacks, sometimes known as flare-ups or exacerbations, is caused by the sudden worsening symptoms of COPD.
Smoking, exposure to tobacco smoke, biomass fuel exposure (cooking with wood, or the agricultural practice of burning the field after each harvest), air pollution, exposure to certain chemicals, dust and fumes in the workplace are known to cause COPD. Only a few cases are caused by a genetic condition.
"COPD means that there's airflow obstruction. The breathing tubes are obstructed or narrowed, making it difficult to breathe," said Dr. Kenneth Chapman, centre director of the University of Health Network, Asthma and Airway in Canada during the "Breathe Free, Break Free" event organised by Swiss healthcare company Novartis.
To get a better grasp of COPD, one must first understand how the lungs function. The breathing tubes, where the air goes in and out, have thousands of smaller tube branches with air sacs. In healthy lungs, air sacs are elastic. Like balloons, they stretch to fill up with air, and shrink during exhalation.
Thick or inflamed
In people with COPD, the air sacs are no longer elastic. The breathing tubes are thick or inflamed, sometimes clogged by mucus, making it harder to get air, comprised mostly of carbon dioxide, out of the lungs. COPD reduces airflow in and out of the lungs, starving the body of much-needed oxygen.
Suddenly, normal daily tasks, such as walking or climbing a few flights of stairs, become a burden. In advanced stages, taking a bath or getting dressed becomes a Herculean task. At some point, people with COPD become fearful of movement, finding themselves out of breath at the simplest of tasks, like brushing their teeth.
COPD comes in two main forms: chronic bronchitis and emphysema, said Dr. Ricardo Zotomayor, co-director of the Institute of Pulmonary Medicine at St. Luke's Medical Center Quezon City.
Chronic bronchitis, a condition marked by the inflammation of the lung airways, is a nasty cough that won't go away. It is a progressive, recurring condition where the damaged airways become filled with mucus that one increasingly finds hard to cough up. Smoker's cough, with similar symptoms, can cause chronic bronchitis.
Emphysema, on the other hand, traps air in the lungs as the air sacs become "flabby," making it hard for one to push air out. With "old" air unable to get out of the lungs, it leaves very little room for fresh air to get in. Breathing becomes laboured.
"That's why they have a more difficult time exhaling than inhaling. They develop that characteristic of prolonged breathing exhalation. If you notice this among your relatives or friends, that is a guy who already has COPD," Zotomayor said.
A lung attack occurs when symptoms quickly progress, becoming worse in a matter of days or even hours. One may be coughing up more phlegm than usual, or may experience greater tightness in the chest area. For instance, a person suddenly cannot walk a few meters away from his/her desk without gasping for breath.
Unfortunately, though, attacks are often mistaken for acute infection. Zotomayor said that physicians themselves do not ask the right questions. After a cursory history and chest exam, for example, and they don't hear any wheezing from the patient, many doctors simply dismiss the case as "just one of those things," and prescribe a cocktail of epileptic medicines and antibiotics.
"We now know that patients who have COPD have actually engaged their physicians repeatedly in the past for symptoms that these doctors never recognised as COPD," Zotomayor said.
Spirometry, one of the diagnostic tools of COPD, is underutilized in the Philippines because many doctors are either not aware of it, or do not know how it will be utilized, Zotomayor said.
As a result, more than 50 per cent are not diagnosed and left untreated. The misdiagnosed cases, given the wrong combination of medications, will experience complications of the disease, such as pneumonia. A late diagnosis can be fatal, as patients will have already lost a lot of their lung function, Zotomayor said.
If you are over 40 years old, a smoker or ex-smoker, and experience chronic cough, chronic sputum production and shortness of breath, you may already have COPD. There is no cure for it, and the damages caused to the lungs are irreversible, but treatment can improve the quality of life.
"COPD is a disease of perpetually unmet needs. With no treatments, our goal now is to reduce the risks as much as possible. We know the disease will progress. But we can reduce the risks for lung attacks," Chapman said.
Novartis Healthcare Philippines also launched Glycopyrronium bromide, a once-a-day inhaler that reduces the symptoms in just five minutes, with effects that can last up to 24 hours. Clinical studies have shown that Glycopyrronium bromide significantly improves lung function and exercise endurance, as well as decreases the risk for exacerbation (flare-ups or lung attacks).
COPD affects 210 million people worldwide, with ages ranging from 50 to 65 years old. In the Philippines, up to 5 per cent of Filipinos have COPD, but only 3 per cent consult a doctor. It is estimated that 50 per cent are not aware they have the disease, according to the Philippine College of Chest Physicians.
"It's downward spiral if not treated. Most patients will have more shortness of breath and phlegm, and coughing. This makes the disease worse. Lung function deteriorates further, they will be hospitalized and it may cause their death," said Dr. Teresita de Guia, chair of COPD Foundation of the Philippines.
Pharmacological intervention, smoking cessation and the introduction of moderate exercise can improve the lives of people with COPD. Glycopyrronium bromide, the new drug from Novartis, is now available at all leading drugstores nationwide.