The hidden threat of chronic lung conditions

According to the World Health Organization (WHO), chronic obstructive pulmonary disease (COPD) claimed 3.2 million lives worldwide in 2015, which amounts to five percent of the total deaths during that year, and is predicted to become the third leading cause of death by 2030.

Despite this, almost 80 percent of individuals with the disease are unaware of having it, Prof Philip Eng, a respiratory specialist practising at Mount Elizabeth Hospital in Singapore, told Global Health and Travel.

This is because the early symptoms of COPD, such as breathlessness, recurrent coughing, chest tightness and the production of mucus, are often mistaken as part of normal aging and considered unworthy of medical attention.  

However, COPD may result in devastating and life-threatening outcome.

“COPD is defined as a progressive lung disease that leads to increased breathing limitations,” explained Prof Eng.

As the disease progresses, normal daily activities, such as exercising, walking up the stairs or going out become increasingly difficult.

This is well demonstrated by one of Prof Eng’s patients – a 75-year-old Indonesian who battled with COPD for more than eight years and he is now in a wheelchair and dependent on oxygen therapy around the clock.

If left untreated, COPD can also lead to a wide range of complications. For instance, 44 percent of hospitalised COPD patients suffer from depression because their quality of life declines, according to a 2007 study conducted by Prof Eng. On top of that, many develop osteoporosis – a condition that makes bones weak and prone to fracture – due to their inability to exercise or even walk.

The root causes of COPD

COPD is caused by chronic smoking, including secondhand exposure, in 80 to 90 percent of the cases, according to Prof Eng.

“The longer you smoke, the greater is your risk of developing COPD,” he said.

Another major cause of COPD is air pollution, especially in lower-income countries.

Air pollution includes outdoor as well as indoor exposure to toxic particles or chemicals. In rural South East Asia, people commonly cook food by burning wood in their poorly ventilated homes, thereby producing toxic fumes that contribute to the development of COPD.

In a minority of cases, genetics can also play a crucial role in the development of the disease. A genetic abnormality causing a lack of a specific protein, called alpha-1 antitrypsin (AAT), may result in the development of COPD, said Prof. Eng. Patients with AAT deficiency may develop COPD in their 40s, while most patients with normal levels of ATT present with COPD-related symptoms only in their 60s.    

Avoiding any form of smoking – from traditional to electronic cigarettes - is the most effective step to prevent COPD, said Prof Eng.

“Aside from not smoking, some preventive measures for those exposed to high levels of air pollution include wearing a mask outdoors and using an air purifier indoors.”

Treatments to put COPD under control

Identifying COPD early is the first way to combat it effectively.

“Individuals at high risk, such as chronic smokers, should consult a doctor if they have persistent COPD-related symptoms like cough, sputum or breathlessness,” explained Prof Eng.

Although COPD is incurable, early treatment can relieve symptoms, improve quality of life and reduce the risk of death.

Typically, symptoms can be controlled with inhalers and some oral medications that help open up the breathing tube, reduce inflammation and improve exercise tolerance.

On top of these treatments, Prof Eng advises patients with severe disease to undergo pulmonary rehabilitation - an exercise programme to help patients with chronic lung disease keep up with daily activities.

When the lungs are severely damaged, long-term oxygen therapy is required to keep patients alive. This therapeutic approach cannot reverse the damage, but it lengthens the lifespan of patients by years, according to Prof Eng.  

Another treatment of last resort is lung transplant, although this is an option for few patients considering that there are not enough organs available for transplantation. For example, in Singapore only one patient out of five manages to survive until a lung is available, said Prof Eng.

Additionally, COPD patients are highly recommended to get vaccinated against influenza and pneumonia, he added.

“Most of these patients have weak lungs and are prone to respiratory infections that can be caused even by the simplest flu, so immunisation helps prevent these problems.”

Prof Philip Eng is a respiratory specialist practising at Mount Elizabeth Hospital in Singapore. He has a keen interest in the evaluation and treatment of chronic obstructive pulmonary disease, chronic cough, asthma, lung cancer and pneumonia. He also teaches at National University of Singapore and Singapore General Hospital.

Mount Elizabeth Hospital
3 Mount Elizabeth, Singapore 228510
Tel: (+65) 6735 5000
www.mountelizabeth.com.sg

Philip Eng Respiratory & Medical Clinic
3 Mount Elizabeth #14-14
Mount Elizabeth Medical Centre, Singapore
Tel: (+65) 6836 0378