{"id":2167,"date":"2021-04-07T14:44:34","date_gmt":"2021-04-07T08:59:34","guid":{"rendered":"https:\/\/medicosnext.com\/?p=2167"},"modified":"2021-04-07T14:46:05","modified_gmt":"2021-04-07T09:01:05","slug":"the-most-common-ncd-in-nepal","status":"publish","type":"post","link":"https:\/\/medicosnext.com\/?p=2167","title":{"rendered":"The Most Common NCD in Nepal"},"content":{"rendered":"

\"\"COPD is a common preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation due to airway and\/or alveolar abnormalities, usually caused by significant exposure to noxious particles or gases. It is the fourth most common cause of mortality globally, with significant effect on socio-economic status, and having significant threat to public health. It is the most common non-communicable disease in Nepal, and alarmingly, the second most common cause of mortality in Nepal and India, which is perhaps because of increased biomass fuel usage and pollution exposure. A significant amount of health budget is utilized only for COPD, and in developing countries, the direct cost may be less important than indirect cost. COPD forces at least two individuals to leave the workplace, which further affects the health of the entire family, especially of economically deprived ones.<\/p>\n

Risk factors for developing COPD<\/strong>
\n\u2022 Smoking
\n\u2022 Biomass fuels (brick making, fish smoking, tobacco curing, and leather working)
\n\u2022 Outdoor and indoor air pollution
\n\u2022 Poverty
\n\u2022 Poor lung development during childhood
\n\u2022 Recurrent respiratory tract infections<\/p>\n

Symptoms<\/strong>
\n\u2022 Difficulty in breathing
\n\u2022 Cough
\n\u2022 Sputum production
\n\u2022 Muscle wasting<\/p>\n

Diagnosis<\/strong>
\nCOPD is diagnosed in patients having above risk factors like cigarette smoking, biomass fuel usage, etc. who have gradually progressive difficulty in breathing, along with cough, in whom pulmonary function test (Spirometry) shows obstruction, i.e. post bronchodilator FEV1\/FVC Ratio <0.70. Ironically, most of the centers here do not have Spirometry, despite it being economical and simple to use, thus relying only on clinical diagnosis that either under-diagnose or over-diagnose COPD many a time.<\/p>\n

Prevention<\/strong>
\n\u2022 Smoking cessation\/ avoidance or minimization of biomass fuel utilization
\n\u2022 Vaccination: influenza (annual) and pneumococcal vaccination
\n\u2022 Education
\n\u2022 Pulmonary rehabilitation\/exercise
\n\u2022 Adherence to treatment<\/p>\n

Treatment<\/strong>
\nCOPD is usually treated with bronchodilator medications like Tiotropium, Glycopyrenium, Formoterol, and Salmeterol, and corticosteroids like budesonide, fluticasone, etc. in various combinations, based on severity of disease. These medications are usually given in inhaler form, which is directly delivered to the lungs, leading to maximum effect and minimal systemic side effects. Most common ways of delivering these drugs are via metered dose inhaler with spacer, dry powder inhaler, breath actuated devices, and nebulization. All these delivery devices are equally good, with no superiority of one device over another. However, selection of device should be individualized and discussed with the patient. Various factors like old age, arthritis, poor inspiratory effort, and cognitive level will help guide one to the best device for an individual.
\nIn addition to the above-mentioned medical therapy, many patients may require long-term oxygen therapy and non invasive ventilator (BiPAP) support at home, based on disease severity. Various surgical options are available outside our nation for advanced stage diseases. However, proper adherence and ineffective use of these devices leads to worsening of conditions. Hence, proper technique should be taught and checked on follow-up visit. Importantly, patient should be given advice regarding nutrition intake. They should be encouraged to eat calorie\/energy-dense food in small amounts and multiple times a day.<\/p>\n

Co-morbidities<\/strong>
\nPatients with COPD come with various common co-morbidities, which should be addressed and treated accordingly.
\n\u2022 Depression\/anxiety\/cognitive impairment
\n\u2022 Cardiovascular diseases like heart failure, ischemic heart disease, and arrhythmia hypertension, etc.
\n\u2022 Osteoporosis
\n\u2022 Lung cancer
\n\u2022 Metabolic syndrome and diabetes
\n\u2022 Gastro esophageal reflux diseases
\n\u2022 Obstructive sleep apnea<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

COPD is a common preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation due to airway and\/or alveolar abnormalities, usually caused by significant exposure to noxious particles or gases. It is the fourth most common cause of mortality globally, with significant effect on socio-economic status, and having significant threat to public health. …<\/p>\n","protected":false},"author":60,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"","jetpack_seo_html_title":"","jetpack_seo_noindex":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[95,39],"tags":[],"class_list":["post-2167","post","type-post","status-publish","format-standard","","category-disease","category-feature"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_likes_enabled":true,"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/medicosnext.com\/index.php?rest_route=\/wp\/v2\/posts\/2167","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicosnext.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicosnext.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicosnext.com\/index.php?rest_route=\/wp\/v2\/users\/60"}],"replies":[{"embeddable":true,"href":"https:\/\/medicosnext.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2167"}],"version-history":[{"count":0,"href":"https:\/\/medicosnext.com\/index.php?rest_route=\/wp\/v2\/posts\/2167\/revisions"}],"wp:attachment":[{"href":"https:\/\/medicosnext.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2167"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicosnext.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2167"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicosnext.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2167"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}