Widespread tobacco smoking, growing environment pollution and use of biomass fuel are the main causes of COPD


 World COPD / Pneumonia Day 2016

Widespread tobacco smoking, growing
environment pollution and use of biomass
fuel are the main causes of COPD

By Mubarak Ali

KARACHI: Widespread tobacco smoking, growing environment pollution and use of biomass fuel are the main causes of Chronic Obstructive Pulmonary Disease. The disease is under diagnosed and under treated in Pakistan. This was the consensus of pulmonary expert gathered at a seminar organized by Chest Health & Education Society in collaboration with Pakistan Chest Society (Sindh) held at JPMC Karachi on  November 16th 2016.   The event was organized to mark the World COPD / Pneumonia Day 2016.

Prof. Nadeem Rizvi, President of Chest Health & Education Society speaking at the occasion said that recurrent attacks of acute chest infection in patients of COPD causes rapid deterioration of disease and increases the mortality associated with COPD. He stressed that these attacks are mostly due to infection and need to be treated with effective antibiotics, under dose and under duration of treatment results in resistance. Globally, it is estimated that about three million deaths were caused by the disease in 2015 (that is, 5% of all deaths globally in that year). More than 90% of COPD deaths occur in low and middle income countries. The primary cause of COPD is exposure to tobacco smoke (either active smoking or secondhand smoke). Other risk factors include exposure to indoor and outdoor air pollution and occupational dusts and fumes. He pointed out that over the counter sale of antibiotic should be prohibited.

Prof. Nadeem Rizvi, Prof. Javed A. Khan, Dr. Mirza Saifullah Baig, Dr. Ashok Kumar, Dr. Nisar Rao, Dr. Naseem
Ahmed, Dr. Muhammad Irfan and Dr. Nausheen speaking at seminar on World COPD / Pneumonia Day 2016,
organized by Chest Health & Education Society in collaboration with Pakistan Chest Society (Sindh)
held at JPMC Karachi on November 16th 2016.

Prof. Javed A. Khan, Professor of Chest Medicine, Department of Chest Medicine, Aga Khan University stated that Smoking by far is the most important cause for COPD. However this chronic respiratory illness can also result because of environmental tobacco smoke. The rising trend of shisha smokingamong the youth of Pakistan could result in exponential increase in the number of cases of COPD in the country. He called for the implementation of clean air laws in the country, which prohibit smoking as well as shisha at all public places including, hotels and restaurants. He regretted that in spite of Sindh Assembly resolution banning the use of shisha in restaurants, it is still being served at all major hotels and restaurants in the city thus endangering health of Pakistani youth. He presented some cases of pulmonology and stated that  steroid is a risk  of PCP Pneumonia, do take  opinion of  a radiologist  but as clinician  we can correlate to have proper diagnosis. 

Dr. Mirza Saifullah Baig, 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 of mankind. Dr. Baig said that 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. He pointed out that in Pakistan around 14% rural female suffering 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 minimize to a great extent.

Dr. Naseem Ahmed, talking about management of COPD said that the disease is under diagnosed because half of the patients with COPD not have significant symptoms and they consider 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. COPD is an emerging disease which is treatable and can be prevented. Diagnosis and treatment is a real challenge.  Symptoms includes shortness of breath, chronic cough and sputum.  COPD patients are at high risk of cardiovascular diseases, diabetes, lung cancer and anxiety etc.

Dr. Nisar Rao, Associate Professor Dow University of Health and Sciences, discussing in hospital treatment of patient having acute exacerbation of COPD said that with the judicious use of antibiotics and steroid, the risk of treatment failure and mortality is reduced in severely ill patients. He described how to use Non-invasive ventilation in COPD patients suffering from respiratory failure. He concluded that continuous smoking, improper use of inhalers and poor adherence to drug therapy is associated with more frequent episode of COPD exacerbation. He advised patients to religiously follow doctor`s advice.

Dr. Muhammad Irfan, talking about prevention of Community Acquired Pneumonia said that it was very common worldwide and causes substantial morbidity and mortality. Its prompt treatment may save many lives; its prevention is even more important. Simple hand washing, covering face while coughing and avoiding smoking are as valuable as medicine to prevent health persons getting infected. Extremes of age and co-existing illness, 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. This talk will deal with current practice for the above.

Dr. Ashok discussed Good nebulization practices and stated that Nebulizers are not always appropriately used in Pakistan. Many patients who ought to be treated with them are not prescribed proper treatment and many others are incorrectly treated. Before Nebulization treatment prescription it’s important to know that for which purpose it is being prescribed. Good Nebulizer are where there is minimum wastage of aerosol and low residual volume. Only those drugs should be used which are advised in nebulization. A preparation to be nebulized must be prepared with sterile fluids, he added.    

Dr. Nausheen Saifullah, while discussing severe pneumonia said that it is a major concern for physician because of high mortality and morbidly assorted with pneumonia. She stressed that physicians treating pneumonia should assess its severity to decide if patient needs hospitalization.