COPD is a common preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. Almost 3 billion people worldwide use biomass and coal as their main source of energy for cooking, heating. 

Epidemiology:
COPD is the leading cause of morbidity and mortality globally with significant effect on socio-economic status and having significant threat to public health. Significant amount of health budget is utilized only for COPD. In Developing countries direct cost may be less important than indirect cost. COPD forces at least two individuals to leave the workplace which further affects the health of the entire family especially to economically deprived ones.
 
•  COPD is the most common non-communicable disease in Nepal. It is increasing significantly globally.  
COPD is the 4th Most Common cause of mortality globally. Alarmingly, it is the 2nd Most Common cause of mortality in Nepal and India which is perhaps because of increased Biomass fuel usage and pollution exposure.

Risk factors for Developing COPD :
•    smoking
•    Biomass fuels (Brick making, fish smoking, tobacco curing, and leather working)
•    Outdoor & indoor air pollution
•    Poverty
•    Poor Lung Development during childhood
•    Recurrent Respiratory tract infections
 
Symptoms :
Difficulty in breathing
COUGH
Sputum Production
Muscle wasting
 
Diagnosis:
COPD is diagnosed in patient having above risk factors like Cigarette smoking, biomass fuel usage etc who had gradually progressive difficulty in breathing, cough in whom  Pulmonary Function Test called Spirometry shows Obstruction i.e. Post bronchodilator FEV1/FVC Ratio <0.70. Ironically, most of the center does not have Spirometry despite its being economical and simplicity. Thence, making only clinical diagnosis which at significant number of times either underdiagnose or overdiagnose COPD.
 
Prevention:
Smoking Cessation/ Avoidance or Minimization of Biomass fuel utilization
Vaccination: Influenza (Annual) & Pneumococcal vaccination
Education
Pulmonary Rehabilitation /Exercise
Adherence to treatment

Treatment:
COPD is usually treated with bronchodilator medications like Tiotropium, Glycopyrenium, Formoterol, Salmeterol and corticosteroids like budesonide, fluticasone etc in various combinations based on severity of disease. These medications are usually given in inhaler form which is directly delivered to the lungs leading to maximum effect and minimal systemic side effects. Most common ways of delivering these drugs are via Metered dose inhaler with spacer, Dry Powder Inhaler, Breath actuated devices and Nebulization. All these delivery devices are equally good with No superiority of one device over other. However, selection of device should be individualized and discussed with patient. Various factors like Old age, arthritis, poor inspiratory effort, cognitive level will help guide best device for an individual.
In addition to above medical therapy, many patients may require long term oxygen therapy and Non invasive ventilator (BiPAP) support in home based on disease severity. Various surgical options are available outside our nation for advance stage diseases.
Moreover, proper adherence and ineffective use of these devices leads to worsening of conditions. Hence proper technique should be taught and checked on follow-up visit. 

Importantly, Patient should be given advice regarding nutrition intake. They should be encouraged to eat calorie/energy dense food in small amount and multiple times a day.

Co-morbidities:
Patients with COPD comes with various common co morbidities which should be addressed and treated accordingly.
Depression/Anxiety/Cognitive impairment
Cardiovascular diseases like Heart failure, Ischemic Heart Disease and Arrhythmia Hypertension etc
Osteoporosis
Lung Cancer
Metabolic Syndrome and Diabetes
Gastro Esophageal Reflux Diseases
Obstructive Sleep Apnea

(Dr. Mishra, Md, MPH , FAPSR Consultant Pulmonologist in KMCTH and Blue Cross Hospital)

Hamro Doctor