Understanding COPD saves you from long term life threatening complication of Air Pollution!

Ramesh, a senior security personnel, smoker, developed cough with white mucoid phlegm and breathlessness. This was there only in winters for past 3-4 years but now it is persistent and has not improved with changing season. He consulted a physician who advised a chest X-ray, sputum for tuberculosis test & Pulmonary Function Test (PFT/ spirometry). The doctor after seeing the reports opined that it is COPD that Ramesh is suffering from. 

COPD has emerged as a health problem which kills about 32 lakh persons per year. About 90% of these deaths occur in low or middle-income countries like India. The Global Burden of Disease Study reports a prevalence of 251 million (25.1 crores) cases of COPD globally in 2016. It is the 5^th leading cause of death & accounted for 5% of all deaths globally in 2016. COPD includes patients of chronic bronchitis & emphysema. Smoking is considered an important risk factor for COPD.

Ramesh started treatment and started reading about it. The reading provoked thought that his mother living in village does have similar symptoms but have never smoked.

Now we understand that this draconian problem is not restricted only to smokers. The Burden of Obstructive Lung Disease (BOLD) study also reports of high prevalence of COPD in non-smokers. About 30% of COPD patients have never smoked. Air pollution, ambient & indoor, and exposure to biomass fuel are important risk factors apart from smoking. In India over 2/3^rd population use solid fuel for cooking energy. According to World Bank, IEA 2017, 40% of world population or 3 billion individuals depends on traditional solid fuels for cooking. And a quarter of this which is about 800 million in India depend upon traditional solid fuel for cooking. The resultant air pollution from use of solid fuels contributes to over 4 million deaths globally as stated by WHO 2016.

Ramesh's mother is member of one of the 200 million household families in India who use solid fuels for cooking. She is exposed to choking pollution of inefficient solid fuel combustion smoke. Her symptoms are much more severe than her son, Ramesh. She can barely walk, becomes breathlessness on even doing daily activities like changing clothes or bathing. Ramesh plans that in his next vacation he will get medical assistance for her mom. One fateful day, he received a call from his dad that his mom is very sick and admitted in hospital. He rushes to his native village and reaches straight to the hospital where his mom is admitted. The treating doctor informs him that his mom suffers from an advanced lung disease i.e. Acute exacerbation of COPD & her oxygen level is too low. She is referred to higher center for further treatment but she succumbs to her disease on the way. Ramesh’s mother is a latest victim to the 5^th biggest killer disease globally. Though now Ramesh understands that prompt and long-term treatment could have averted this tragedy, but now it’s too late. Lower lung volumes (FEV1) on PFT/spirometry is a risk factor for life threatening attacks or exacerbations. Treatment for COPD in his mother could have increased her baseline FEV1 and changed the outcome. He is distraught but vows not to smoke and get a LPG connection for cooking. 

Quitting smoking and decreasing or eliminating solid fuel with better energy options and reducing air pollution are only preventive measures to stop the deadly COPD. Politico-social commitment is of paramount importance in reigning this devil. Ujjwala program run by Government of India, under which LPG connection are being given to underprivileged families to shift to cleaner cooking energy, is a big step towards the goal. It has benefitted 20 million (2 crore) families and aim to raise the figure to 50 million (5 crore) by 2019. 
COPD is projected to become the 3^rd killer disease by 2020. It’s time to take a wakeup call and be aware of COPD. Knowledge is prevention & prevention is only cure for COPD.