COPD cases in Nepal (Overview, Causes, Symptoms, Treatment)
Posted on : September 14, 2020 by Clinic One on Respiratory Diseases
Chronic Obstructive Pulmonary Disorder, abbreviated as COPD is the gradual deterioration of the airways of our lungs mostly characterized by the combination of chronic bronchitis and emphysema.
Although COPD is common among the elderly population especially with people after the age of 50, it usually starts in their 30’s, and ‘40s but mostly goes unnoticed.
Eventually, peoples start showing different respiratory abnormalities such as limitation and shortness of breath or breathlessness medically termed as dyspnea, persistent cough, or sputum production.
Chronic bronchitis and emphysema are two major conditions that characterize COPD which may persist simultaneously and may vary in their severity among different individuals.
Chronic bronchitis is a condition were bronchial tubes (airways of the lungs) that facilitate in carrying the air to and from the air sacs of the lungs has inflammation and thus narrowing.
When this condition persists, cells in the lining start overproducing mucus which can further block the airways thus resulting in persistent coughing to clear out the airways.
It thereby produces sputum and consequently develops COPD.
Similarly, emphysema is a condition where the alveoli (air sacs) are damaged due to cigarette smoke or other irritants and particulate matters.
It can stretch and damage the fragile and elastic walls of the air sacs (alveoli) such that it can result in a persistent cough and difficulty breathing and developing COPD.
Causes and Risk Factors
While smoking is considered to be the primary risk factor for the development of COPD, frequent exposure to polluted air and the environment including the exposer with toxic and harmful particles and gases such as in their workplace can also promote the development of COPD.
Moreover, some people might also have a genetic predisposition to develop COPD from their parents.
Nonetheless, long term tobacco smoking is by far the most singled out and statistically notable cause of COPD in developing countries.
Along with the constant exposer to burning fossil fuel in the kitchen or poorly ventilated homes, like that in our country.
Eventually, in most cases, even when an individual quits smoking, the damage has already been done, so that it might just reduce the progression of the severity of the disease and not permanently cure it.
Since (COPD) is a progressive disease that develops slowly over time, one may not be aware of it until later age such as after their 40’s and 50’s.
This typically limits the scope of diagnosis and thereby treatment early on exacerbating the condition such that later treatment procedure could only limit the progression of the severity of the disease and may not be able to cure it.
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Here are some major signs and symptoms one want to access.
Difficulty in breathing is the foremost symptom of this condition. It may be characterized by breathlessness which is medically called dyspnea.
This may be more pronounced while you are involved in some kind of heavy exercise or you may simply wake up at the middle of the night feeling breathless.
2. Persistent cough
This is the second most important symptom to get notified of especially if you have a cough in the early morning and the condition persists for a long time.
3. Frequent chest infection
COPD may bring about frequent chest infection in an individual as the airways and its lining (epithelium) cells are malfunctioning.
It can be because of swelling or irritation of bronchial tubes producing more sputum as is the case with chronic bronchitis.
Or because of dilated, damaged, or stretched air sacs as is the case with emphysema.
4. Persistent wheezing
Inflammation of airways that produces a narrowing and thereby a strange sound while breathing is called wheezing.
And this is a characteristic feature of COPD.
Treatment of COPD
There is no permanent cure of COPD to date while the treatment procedures involved are only designed to slow down the progression of the severity of the disease and control the symptoms.
The following are some treatment procedures that are employed
1. Quit smoking
Since most of the cases of COPD are in large part due to the long term effect of smoking, it is essential to quit smoking to minimize the damage further.
Although quitting smoking may not ensure the permanent cure, as the damage to the alveoli (air sacs) are sometimes irreversible in the case of long term smoking.
Nevertheless, it can limit the further progression of the severity of the disease and control the symptoms such as coughing and breathlessness.
While on the contrary, in its initial stage of the development of COPD, quitting smoking may be all that is needed.
2. Use of Inhalers
If you are having problems breathing due to COPD, doctors can prescribe you inhalers that contain bronchodilators.
These inhalers contain medicines that you breathe in and thereby expose the medicines directly to your lungs.
Medicine therefore when comes in contact with your bronchioles acts by relaxing the airways and aids you in the breathing process.
There can be 2 types of bronchodilators in use, one that is short-acting and the other that has some prolonged effect for example 12 hours.
If you experience breathlessness occasionally then your physician may recommend you short-acting inhalers which can be used almost 4 times a day.
While if you experience breathlessness throughout the day then you may be recommended a long-acting one which can function for almost 12 hours.
If the inhalers are not sufficient to ease your breathing problems, then your doctor might recommend you some tablets.
These are theophylline tablets that act similarly to inhalers by reducing the inflammation and thereby relaxing the airways.
Since it may have some side effects, thus you may need to quantify the level of medicine in your blood regularly so that your doctor might recommend you the best possible dose to control the symptoms while reducing any kind of side effects.
Your physician might recommend some mucolytic medication such as carbocysteine if you have symptoms such as persistent cough.
It will aid in making the phlegm of the throat thinner and makes it easier to cough.
Sometimes a short course of steroid tablets of almost 5 days is recommended if the conditions flare-up.
Usually, long term use of steroids tablets can induce some troublesome side-effects. It helps in reducing inflammation in your airways.
In the case of chest infection, as evaluated by your physician, some antibiotics may be prescribed until the chest infection is deemed normalized.
The situation of COPD in the Global Scene:
The Lancet journal on Respiratory medicine reports that 544.9 million people worldwide are suffering from some kind of chronic respiratory disease in the year 2017.
This is an increasing trend of almost 39% as compared to the number of people affected in 1990.
Similarly, global data suggests that (10-20) % of the world’s population older than 40 years, equivalent to 80 million have a case history of COPD which is the subset of chronic respiratory disease.
Moreover, it results in almost 3 million deaths annually, making it the 4th highest leading cause of death globally at present, while it is estimated to be the 3rd leading cause of death by the year 2020.
The situation of COPD in Nepal
While in the case of Nepal, COPD bears the patient load of 43% of all non-communicable diseases and also accounts for 2.56% of total hospitalization.
This situation is aggravated in the case of Nepal, since almost 85% of households still rely upon biofuels such as wood and others to cook for their meal, thus making Nepalese women more prone to the development of COPD due to indoor air pollution.
Additionally, almost 15% of Nepalese women are tobacco smokers which consequently leads to the distressing condition of almost 60% of Nepalese women diagnosed with COPD according to the research published by the author Ramjee Bhandari in his article published in 2012.
The situation is made worse by the fact that health literacy among our people is not so high as compared to the developed western countries.
This is reflected by the study conducted by the author Abha Shrestha in 2018.
The study reveals that our population in different brackets such as older, females, poor, uneducated, and retirees had very lower levels of health literacy and thereby the condition of their disease.
This is the main limitation that needs to be sorted out which can ultimately hinder improving the stake of COPD in the country.
But this is not to say that situation of incidence, prevalence, and hence the mortality rates due to COPD cases are on the rise in Nepal.
Things are improving gradually but steadily as the general awareness of health and hygiene is increasing. As well as the dependency on biofuel is decreasing day by day with the emergence of modern cooking techniques.
All this is reflected in the data compiled by the author Tara Ballav Adhikari, on his report that compares the health burden of COPD in Nepal with respect to “age-standardized mortality rate” (ASMR) due to COPD by age and sex through the years 1990 – 2016.
Results suggest that there is a decline in (ASMR) due to COPD for both sexes, but the decline is notably higher in males than compared to females. The statistical results below compare and gives us a glimpse of an improving situation where the decline in (ASMR) is noted.
Fig: Age-Standardized Death Rate (ASDR) of (COPD) in Nepal through (1990-2016)
Therefore, increasing health literacy among our population in order to understand the risk factors contributing to COPD so that they can be motivated to adopt healthy lifestyle habits and choices are vital in mitigating the incumbent surge of COPD in Nepal.
Not to mention, the role of our government in making their policies to better facilitate and equip the medical centers for timely diagnosis and proper treatment along with increasing the general awareness at the community level is pivotal.
Abha Shrestha, et al (2018) Health Literacy and Knowledge of Chronic Diseases in Nepal, Health Literacy Research and Practice, Vol.2, No. 4
Markus MacGill (2017) Medical News Today, What is emphysema?
National Health Service (NHS) (2019) Chronic Obstructive Pulmonary Disease (COPD), Symptoms and treatment
Tara Ballav Adhikari, et al (2018) Burden of COPD in Nepal, International Journal of COPD, Dove Press
The Lancet Respiratory Medicine (2020) Prevalence and attributable health burden of chronic respiratory disease, 1990-2017: a systematic analysis for the global burden of disease study 2017, GBD Chronic Respiratory Disease Collaborators
Global Initiative for Chronic Obstructive Lung Disease (2020), Report
Ramjee Bhandari, et al, (2012) Epidemiology of chronic obstructive pulmonary disease: a descriptive study in the mid-western region of Nepal, International Journal of COPD