Increasing trend of Shisha smoking should be checked as Shisha Cafés are death cells - Prof. Javed Khan

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Tobacco is a major cause of COPD
Increasing trend of Shisha smoking
should be checked as Shisha Cafés
are death cells - Prof. Javed Khan

Inappropriate medication dose and treatment
for inadequate duration results in
resistance - Prof. Nadeem Rizvi

By Mubarak Ali

KARACHI: Widespread tobacco smoking, growing environmental pollution and use of biomass fuel are the main causes of Chronic Obstructive Pulmonary Disease (COPD). The disease is under diagnosed and under treated in Pakistan. These views were expressed by speakers at a seminar on the World COPD / Pneumonia Day 2012 organized by Chest Health & Education Society and Department of Chest Medicine JPMC, Karachi recently.
Prof. Javed. A. Khan, Professor of Medicine at Aga Khan University, Karachi speaking at the occasion said that Smoking by far is the most important cause for COPD, However this chronic respiratory illness can also be due to environmental tobacco smoke. The rising trend of Shisha smoking among the youth of Pakistan could result in exponential increase in the number of COPD cases in the country. Shisha Cafés trend is very popular in our posh areas which are playing havoc with the lives of our young generations. These Shisha Cafés are deaths cells, he added. All over the World Pizza Hut are smoke free but in Pakistan smoking is allowed and no one is bothered about it because health is not priority with our rulers. He called for the implementation of clean air laws in the country, which prohibit smoking as well as Shisha use at all public places including hotels and restaurants. He regretted that in spite of a Sindh Assembly resolution banning the use of Shisha in restaurants, it is still being served at all major hotels and restaurants in the city.
Prof. Nadeem Rizvi, President of Chest Health & Education Society stressed that current attacks of acute chest infection in patients of COPD cause rapid deterioration of disease and increases the mortality associated with COPD. Cost of treatment for an exacerbation is very high, use of antibiotics in AECB at least can prevent attacks. He stressed that these attacks are mostly due to infection and need to be treated with effective antibiotics. However, inappropriate medication dose and treatment for inadequate duration results in resistance. Over the counter sale of antibiotics should be prohibited, he added. Prof. Nadeem Rizvi highlighted the findings of the MAESTRAL study which was conducted in one hundred fifty sites of thirty countries. Pakistan was also part of the this study and Department of Chest Medicine, JPMC Karachi reported high number of patients in this study. Findings of this study showed that amoxicillin/clavulanic acid was more effective than moxifloxacin in the treatment of AECOPD but safety profile was same and both therapies were well tolerated.
Dr. Mirza Saifullah Baig, from Dow University of Health Sciences, highlighting the global burden of COPD said that it is now a major killer disease in the world. According to a recent estimate at present it is the 5th leading cause of death and if present trend of smoking and pollution continue it will become the 3rd biggest killer disease. Due to better prevention and management strategies there has been a reduction in mortality from chronic heart disease and stroke but the mortality for COPD have gone up in the last decade. In Pakistan around 14% rural female suffer from COPD compared to 9% in men. This is probably due to extensive use of biomass fuel in rural areas of Pakistan. With proper ventilated houses having chimneys this can be minimized to a great extend, he added.
Dr. Musavir Ansari addressing the participants said that COPD is under diagnosed because half of the patient with COPD may not have significant symptoms and they count chronic cough and phlegm as a normal part of getting old or smoking cigarette. They seek medical advice when they become short of breath despite the fact that a simple, painless breathing test “spirometer” can diagnose their disease early and easily. He stressed that the management modalities and improvisation of treatment should be based on evidence.
Dr. Nisar Rao, from Dow University of Health & Sciences, talking about treatment of inpatient having acute exacerbation of COPD said that the judicious use of antibiotics and steroid reduces the risk of treatment failure and mortality in severely ill patients. He described how to use Noninvasive ventilation in COPD patients from respiratory failure. Continueous smoking, improper use of inhalers and poor adherence to drug therapy is associated with more frequent episode of COPD exacerbation, he concluded.
Prof. Sohail Akhtar, from Ziauddin University, Karachi discussed the Prevention of Community Acquired Pneumonia. Pneumonia, he stated is very common worldwide and causes substantial morbidity and mortality. It is difficult to diagnose and treat. Cigarette smoking is recognized as an independent risk factor of pneumonia. Its prompt treatment may save many lives. Its prevention is even more important. Simple hand washing can cut the risk of respiratory infection by 16% , covering face while coughing and avoiding smoke are as valuable as medicines to prevent healthy persons getting infected. Extremes of age and co-existing illnesses, especially immune-compromising states are major reasons for micro-organisms manifesting the disease. Vaccines for influenza and pneumococcus, the two most common organisms are available and effective if used in selected cases at the appropriate time. PCV-13 conjugated vaccine has confirmed its efficacy in young children against pneumococcal diseases. All persons more than fifty years of age and healthcare workers must have influenza vaccination he added.
Dr. Ali Bin Zubairi, from AKUH while discussing severe pneumonia said that it is a major concern for physician because of high morbidity and mortality. Physicians treating pneumonia should assess its severity to decide if patient needs hospitalization, he added.