A silent epidemic, chronic obstructive pulmonary disease is preventable but, worryingly, under-diagnosed
Devidas Hari Tayade is a labourer in the Yawal Taluka in Maharashtra’s Jalgaon district. Addicted to bidis since he was 13, Tayade worked as a milkdelivery boy, and then moved to digging wells in his village for the next 20 years.
Around eight years ago, he started experiencing acute shortness of breath—a feeling that no matter how hard or deeply he inhaled, his lungs always felt short of air. “I attributed this to the heavy work,” he says. But the discomfort persisted, eventually compelling him to move to Pune to work as a watchman. Eight months ago, on his wife’s insistence, he got himself examined. This was when 68-year-old Tayade was diagnosed with Chronic Obstructive Pulmonary Disease (COPD). However, he is yet to give up on tobacco, a leading cause of this condition. “I smoke only 10 or 11 bidis a day; it used to be 50 earlier,” he admits.
Across the country, in Kolkata, lives 82-year-old Krishna Kamal Das, formerly a busy executive and a regular smoker 40 years ago. Das would suffer from frequent bouts of cough and cold, but each time a phase began, he would brush it off. “Every time I travelled abroad, my cough would disappear, but the moment I returned to Kolkata, it came back,” he says. It was only after he retired that his cough gradually turned worse, frequently accompanied by breathlessness. A visit to a pulmonologist confirmed COPD.
The term COPD was coined as recently as 1965. The World Health Organization (WHO) identifies it as an umbrella term used to describe chronic lung diseases that cause limitations in lung airflow. COPD leads to a narrowing of the airways and reduction of the elasticity of the air sacs that make up the lung tissue. As a result, a patient cannot exhale fully, leading to reduced oxygen intake, and hence, oxidative stress (a condition where the body does not absorb enough oxygen due to stiffness of the lungs). According to the WHO, chronic bronchitis and emphysema are the two most common conditions that are included within COPD, the symptoms of which are “breathlessness, excessive production of sputum and a chronic cough”.
NOT JUST A ‘SMOKER’S DISEASE’
India has the second highest number of people dying of COPD, after heart disease, as per the Global Burden of Disease study, 1990–2016. It states, “The contribution of chronic respiratory diseases to the total DALYs (Disability-Adjusted Life Years) in India increased from 4.5 per cent in 1990 to 6.4 per cent in 2016.” It further points out that “of the total global DALYs due to chronic respiratory diseases in 2016, 32 per cent occurred in India” and “the number of cases of COPD in India increased from 28.1 million in 1990 to 55.3 million in 2016”.
According to the US-based COPD Foundation, most people suffering from this disease are exposed to toxins, including tobacco smoke (firstor second-hand), chemicals, such as ammonia or asbestos, household irritants such as dust, bacteria, mould and other air pollutants such as carbon monoxide. Also, according to the State of Global Air report, 2019, these, as well as outdoor particulate matter (PM)—the potentially hazardous solid and liquid particles suspended in air—ozone and household air pollution have been linked to increased hospitalizations, disability and death from respiratory problems, heart disease, stroke, lung cancer and diabetes. Those not exposed to such factors could still get COPD due to a rare genetic condition that predisposes them, according to the British Lung Foundation.
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