World COPD Day 2019: Why this lung disease is still under-diagnosed in India

Half a million Indians die every year due to chronic obstructive pulmonary disease or COPD. A major cause for this is a lack of awareness and underdiagnosis of the disease. On World COPD Day today, let’s look at the causes, symptoms and prevention of this lung disease. “Over the years, the incidence of COPD has increased dramatically in the country," said Dr Inder Mohan Chugh, Director, Interventional Pulmonology and Sleep Medicine, Max Super Specialty Hospital, Shalimar Bagh, New Delhi. “Often people mistake breathlessness and coughing as a sign of old age. However, increasing breathlessness is a red flag for COPD. The term COPD is an umbrella term to describe lung diseases and it can develop for years in the human body without noticeable shortness of breath. The disease is characterized by an obstruction of airflow into and out of the lungs that makes breathing difficult,” he explained. According to data from the Global Burden of Diseases Study, published in The Lancet, a peer-reviewed journal, COPD was responsible for 75•6% of the chronic respiratory disease DALYs in India in 2016. DALYS or disability-adjusted life years is a measure of how much time one loses from a potentially healthy and productive life to disease. On World COPD Day today, let’s look at the causes, symptoms and prevention of this lung disease.

A day of awareness

COPD is not a single disease but a group of diseases primarily comprising chronic bronchitis and emphysema. Chronic bronchitis occurs when your airways become inflamed. It leads to an increase in mucus production in the lungs which manifests as wheezing, cough and muscle pain. Emphysema, on the other hand, involves permanent damage and disfiguration of the air sacs in the lungs. As a result, patients tend to feel breathless more often. Lack of oxygen in their body often turns their fingernails blue. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) organises World COPD Day each year on the third Wednesday of November. It falls on 20 November this year. Launched in 1997, GOLD was started jointly by the World Health Organization (WHO), the National Heart, Lung and Blood Institute and the National Insititute of Health, US. GOLD’s theme for this year, “All Together to End COPD”, is a call to action to raise awareness, improve diagnosis and access to treatment. Though the path is not as straightforward.

The COPD burden

COPD is currently the fourth major cause of death in the world. Experts say that within a decade it could be the third-biggest cause of death worldwide. There are at least three reasons why diagnosing this condition is hard. One, most people think that shortness of breath is the only major symptom of COPD. Two, they sometimes confuse it with other lung diseases like asthma. And three, those who do have some basic information about COPD believe that this disease is limited to smokers. Of course, there are other problems, too: not all technicians use the right diagnostic tools for COPD. The gold standard is the spirometry test - instead of relying on the patient’s account of their medical history and symptoms. As a result, COPD is majorly under-diagnosed. This is especially true of rural areas. A 2012 study showed that they found twice as many COPD cases in rural India when they used spirometry for diagnosis. A spirometry test is a simple procedure that estimates your lung capacity by checking the amount of air you can blow out in a single breath. If you have COPD, you won’t be able to blow out as much air as you can inhale.

COPD versus Asthma

The confusion between COPD and asthma, though understandable, is easy to fix. The confusion arises because both diseases obstruct airflow in the lungs, and both COPD and asthma patients experience shortness of breath. However, the two are a bit different in presentation, causes and their effects on the lungs. For example, the causes for each condition are different: smoking is said to be the major cause of COPD; however, studies suggest that air pollution and smoke from biofuels have a greater contribution to COPD burden. There is no known reason for asthma. Unlike COPD, the narrowing of airway here occurs more due to inflammation than mucus collection. Some of the differences between asthma and COPD that are easier to identify are:

• Asthma is usually triggered by allergens, dust or pollution and can be worse in some seasons. COPD can flare up without exposure to any external substance.
• COPD patients get a cough with phlegm in the morning, while asthma patients more commonly get chest tightness and wheezing at night.
• Most commonly, asthma shows up in childhood and may improve in adulthood. COPD most commonly appears around 40 years of age and worsens gradually.
• Apart from acute attacks, asthma patients have normal lung function. Those with COPD have poor lung function all the time.
• Asthma patients don’t suffer from lung damage and show normal X-rays. However, a person with COPD will have abnormal chest X-ray results, showing airway damage or other effects on the lungs.

As the famous saying goes, knowledge is power. “Health days” like the World COPD Day are excellent reminders of how we can stay healthy, by staying up-to-date. Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health. For more information, please read our article on Chronic Obstructive Pulmonary Disease: Causes, Symptoms, Treatment.