BREATHING is a natural bodily function that most take for granted.
For many Trinbagonians, just taking a breath can be a strenuous task as inhaling and exhaling is a constant struggle.
Chronic Obstructive Pulmonary Disease, or COPD, refers to a group of respiratory conditions within the lungs that block airflow and make breathing difficult.
This illness affects many in Trinidad and Tobago (TT). According to the BOLD-TT (Burden of Obstructive Lung Disease in TT) study, done in 2018 by Professor Terrence Seemungal of the University of the West Indies, about one in every ten people in TT has COPD.
The group of conditions that define COPD are Emphysema and Chronic Bronchitis. Emphysema is a condition that makes it hard for you to exhale, while Chronic Bronchitis is a result of chronic inflammation that makes it hard to inhale as well as exhale. These conditions progress over time. In TT, as stated by the BOLT-TT study, the most common cause of COPD is tobacco, but a significant number of COPD patients have never smoked.
COPD may also be caused by indoor and outdoor pollutants, including second hand smoke. There was also an association established between COPD and dust on the job site. A small percentage of COPD cases are caused by a genetic disorder. Unfortunately, many who suffer from COPD remain undiagnosed.
In the normal lungs, airways carry air in and out. Healthy airways and air sacs in the lung are elastic and can bounce back to their original shape after being filled with air and stretched, just the way a new rubber band or balloon does.
This elastic quality helps retain the normal structure of the lung and helps move the air quickly in and out. In people with COPD, the air sacs no longer bounce back to their original shape due to emphysema. Also, the airways can also become swollen, and mucus production might increase, making it even harder to get air in and out of the lung. This is due to chronic bronchitis.
Symptoms of COPD include; chronic cough, sometimes called smoker’s cough, especially with excess phlegm or mucus, and shortness of breath or wheezing. These symptoms have a significant impact on a patient’s daily activities.
People with COPD often have trouble just doing simple activities like; running errands, walking, climbing stairs, gardening, light house work, grocery shopping or even simpler tasks like bathing and getting dressed. COPD develops slowly and can worsen over time. The symptoms are often dismissed as a normal consequence of aging or being out of shape.
In addition to these chronic symptoms, patients periodically experience flare-ups when symptoms get more severe than usual, and could even mean a trip to the hospital. If these symptoms sound familiar, especially if you are a smoker or you used to smoke, it is very important to visit your doctor and have a breathing test called spirometry which is done to confirm the diagnosis. It can detect COPD early before it becomes severe. It is a simple breathing test that measures how much air you can blow out of your lungs and how fast you can blow it out. Based on this test, your doctor can tell if you have COPD, how severe it is and the best course of treatment. Early diagnosis and treatment is the best way to help slow the progression of the disease.
Prevention is the best treatment, and since most COPD is caused by smoking tobacco, quitting smoking or, better yet, never smoking in the first place, are the best ways to avoid developing COPD.
Unfortunately, for patients diagnosed with the condition, there is no cure for COPD.
All that can be done is to employ measures to slow the progression of the disease and control symptoms.
Smokers should make every effort to quit smoking and a visit to the doctor can assist. Just because you have already developed COPD, does not mean it is too late to quit.
Quitting can slow the progression of COPD and may mean fewer symptoms and flare-ups, thus less chance of having to go to the hospital.
Also, reducing exposure to air pollutants in the home, such as second hand smoke, can go a long way in preventing the disease. In addition, people exposed to dust, chemicals or fumes at work, should always use the proper protective equipment.
A very important aspect of treatment for all COPD patients is pulmonary rehabilitation. It combines patient education, learning breathing techniques and exercise training to improve your quality of life.
Your doctor, in consultation with your physiotherapist, can devise personalized plans to help manage your symptoms and improve your stamina, thus helping you stay more functionally active. There are also medications available to treat COPD, e.g. bronchodilators and corticosteroids.
It is important to follow your doctor’s instructions in using these medications. So, if your doctor tells you to take a medication every day, DO NOT skip a dose because you feel okay even for one day. Such medications make it easier to breathe by relaxing the muscles around your airways and by fighting inflammation of the airways.
If COPD causes low blood oxygen levels, your doctor may also prescribe supplemental oxygen from a portable oxygen tank. In severe cases surgery may be recommended. The long-term treatment of COPD is very important as it can improve symptoms, reduce flare-ups and improve overall quality of life.
Respiratory infections can trigger a flare-up of symptoms. So, certain vaccines, such as flu and pneumococcal vaccines are recommended for people with COPD.
More information about COPD can be sought at the Chest Clinics at the various Regional Health Authorities and the website of the Thoracic Society of T&T (TSOTT) – https://tsott.org/
Dr Visham Bhimull is a Primary Care Physician MBBS (UWI) Diploma in Family Medicine (UWI)