Breathlessness and Potential Dangers

THE  CHRONIC obstructive pulmonary disease (COPD) is a lung disease that many Malaysians are unaware of. Heavy smokers are known to be the most at risk of contracting COPD, as smoking is the main cause of the disease, followed by household and outdoor air pollution.

According to pulmonologist Dr Mohd Arif Mohd Zim at KPJ Damansara Specialist Hospital 2, COPD occurs when there is an abnormality in the airways and/or alveoli. Patients experience chronic inflammation in the airways, which causes persistent and progressive airflow obstruction.

There are two types of COPD: emphysema and chronic bronchitis. Common symptoms between the two types include coughs, shortness of breath and wheezing. People with chronic bronchitis, however, are likely to have more forceful coughs and produce a lot of phlegm while the shortness of breath among emphysema patients will greatly hinder them in walking and climbing stairs.

Dr Arif shares the key reason COPD goes underdiagnosed globally and in Malaysia, “People often fail to detect COPD in its early stages as they believe all they have is the typical cough. In fact, some folks do have the typical cough while others do not exhibit symptoms. Hence, COPD may already be at a late stage when they start to exhibit symptoms.”

Among the first steps for a doctor to determine if patients have COPD is to examine if patients have a history of smoking. Are they also often exposed to biomass fuels or air pollution?

Dr Arif explains that when a patient goes in for an examination, a doctor will auscultate for a decrease in breath sound or wheezing through a stethoscope. These are signs for a chest x-ray to be taken to detect any abnormality. A patient will undergo a lung function test, also known as spirometry, to confirm that it is COPD. 

COPD and Asthma  

Both chronic inflammatory disorders, which affect the tiny airways and restrict airflow, are the result of interactions between genes and the environment. They are typically marked by mucus and bronchoconstriction. Both asthma and COPD are frequently characterised by airway hyper-responsiveness – airways that are extremely sensitive to what is breathed in.

While shortness of breath may appear to be identical on the surface, a person with asthma can go for extended periods without experiencing an asthma attack while someone with COPD will experience persistent and worsening shortness of breath, even with medication. COPD is more chronic as the narrowing of the airways cannot be reversed.

Those who have asthma are more likely to be diagnosed during childhood but with COPD, symptoms usually show up in those who are above 40, smokers or former smokers.

Dr Arif emphasises the difference between the causes and triggers of asthma and COPD. “COPD is primarily caused by long-term exposure to irritants like tobacco smoke, air pollution, and occupational dust and chemicals and is often seen in people with a history of smoking while asthma is genetically inherited and triggered by allergens such as pollen, dust mites, animal dander, respiratory infections, exercise, cold air and irritants.”

A need for greater awareness and lifestyle changes 

Dr Arif laments the low level of awareness of COPD in Malaysia, citing the high level of media attention and advertisements on issues such as heart attacks when it comes to the dangers of smoking.

He says, “I believe people are generally more conscious of heart problems. But you already know that smoking causes heart problems. We tend to forget mentioning that COPD can develop if you smoke, and that COPD patients have higher rates of what you would refer to as a cruel death.”

Another unfortunate truth is that there is currently no cure for COPD. However, several lifestyle changes can be taken to mitigate its effect. The most important change is for smokers to quit smoking. Incorporating daily exercises such as brisk walking can also be beneficial.

Dr Arif emphasises COPD effects can improve with the right action. “You must be taking the appropriate medications. To receive proper care, you must visit the right doctor once you stop smoking and adopt a healthy lifestyle. Once you start taking your prescription, you will feel better.

“People must also take precautions to prevent themselves from becoming infected. Be vaccinated. Pneumococcal vaccination is given five times yearly and influenza vaccination is given annually.”                                                                                                                                                                             

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