Medicosnext
Dr. Deebya Raj Mishra, DM, European Diploma in Respiratory Medicine, is Associate Professor of the Department of Pulmonary, Critical Care and Sleep Medicine at B.P. Koirala Institute of Health Sciences, Dharan, Nepal
In this issue, we reached out to Dr. Mishra to talk about chronic respiratory diseases (CRDs), their risk factors, available treatments and drugs, and what we can do to keep our lungs healthy.
Chronic respiratory diseases are leading causes of morbidity worldwide. What is the prevalence and incidence in Nepal?
As per NCD country profile 2018 published by WHO, chronic respiratory diseases re the second most common cause of mortality (10%). The prevalence of COPD in general population varies from 5% to 15 % in different studies.
What are the most common respiratory diseases prevalent among Nepalis, and what make them susceptible?
The commonest are COPD, tuberculosis and post tubercular lung conditions, asthma, and lung cancer, followed by bronchiectasis and interstitial lung disease. Smoking, as well as exposure to indoor air pollution, increases susceptibility to COPD, lung cancer, and tuberculosis. Besides malnutrition, overcrowding, as well as endemicity of tuberculosis, makes its incidence high in our population.
Which groups of people are more vulnerable to chronic lung
diseases?
Actually, it depends on the diseases per se. Increasing age with a background of smoking increases the incidence of COPD, post TB bronchiectasis, or lung cancer.
Youth and adults with underlying allergic tendency are more vulnerable to asthma. Increased exposure to rising air pollution level (specially in Kathmandu) makes exacerbations of both COPD and asthma more likely.
What are the preventable risk factors?
Smoking would be the biggest, followed by exposure to air pollution and malnourishment.
According to a NHRC report-2019, about 10% of the total deaths across the country are caused by chronic obstructive pulmonary diseases (COPD) surpassing all non-communicable diseases—coronary artery disease, diabetes, and kidney disease.
What are the effective measures to identify and treat COPD?
The most important thing is the recognition of the disease. More often than not, the disease goes undiagnosed in the early stages. Even when diagnosed, the adherence to inhaler medication is very low. Inhalers in themselves are almost a taboo, and much goes into convincing patients to take them up. Even more effort goes in to teaching them the correct technique, without which these expensive medications are not that useful. The right way forward would be to implement screening for COPD, specially in smokers and the elderly, as well as never-smokers but with significant exposure to indoor air pollution.
Is the prevalence of COPD higher in men?
In the largest population-based study in Nepal published in 2019, the prevalence in males was 12.6%, while that in the females was 11 per cent. At the same time, the 2019 STEPS survey shows that 28% of males are current smokers, whereas the rate is 7.5% in women. Thus, both these data point towards the trend that its highly likely that the prevalence of COPD is higher in men.
What are the COPD risk factors for non-smokers?
The biggest risk factors are exposure to indoor air pollution, followed by exposure to secondhand smoke and outdoor air pollution. At the same time, even the effects of chronic diseases like asthma and post tuberculosis can lead to a picture very similar to COPD.
What are the signs to look out for respiratory problems in children?
Persistent coughing and noisy breathing would be the commonest, followed by absence of weight gain, which could suggest a chronic underlying lung condition.
Given that Nepal has the worst air quality in the world, causing 42,100 deaths due to dirty air in 2019 alone, what is the biggest impediment to clean air?
I guess, lack of policy is the biggest impediment. Combating air pollution needs realization of the same, followed by an enormous investment of time, resource, and political will. I think Beijing would be the right model to learn from, considering the success they have had from the late 90s to the present day.
What is the impact of coronavirus on different parts of the respiratory system? Does pre-existing respiratory problems in patients worsen COVID-19 disease severity?
COVID primarily involves the lungs, and as we all can realize now, can have both acute as well as chronic effects. For the second part of the question, the answer is still tricky. A recent publication in Lancet with data at population level showed that people with COPD and interstitial lung disease appear to have a modestly increased risk of sevWere disease, whereas in those with asthma, the risk of severe COVID was relatively small. In our own practice, we have not observed any striking worsening of COVID in those with pre-existing respiratory problems, compared to the general population.
What treatments and drugs are prescribed for respiratory diseases?
The main drugs for chronic obstructive diseases are inhalers. As we already mentioned, the acceptability for these forms of treatment is very low. This is compounded by wrong technique. Thus, a concerted effort has to be made at all levels to both increase the acceptability, as well as teaching and reinforcing the correct technique during each visit or opportunity. Another is the importance of vaccination, specially against pneumococcal disease and influenza. These vaccinations do help decrease the number of exacerbations in people with chronic respiratory diseases.
How can we strengthen our lungs?
Stop smoking if you smoke. Continue never ever smoking if you are a non-smoker. Stay away from secondhand smoke and air pollution, both indoor and outdoor. Wear your mask. Physical exercise as well as breathing-focused exercises. Also, the usefulness of “pranayama” cannot be overstressed, and this is something that we all should be taking up. Make “pranayama” and “no smoking” the buzz words for lung health.
