Spotlight Series - A Personal Perspective on COPD

When health professionals refer to Non Communicable Diseases (NCDs), they often allude to the diseases of obesity, type 2 diabetes, cancer and cardiovascular disease. However there is a disease which is often forgotten. It is a disease which is the second most common hospital admission in the UK, the fifth most common cause of death in high income countries and the sixth most common in low to middle income countries. I’m referring to Chronic Obstructive Pulmonary Disease (COPD) and it could be considered as the forgotten NCD in Global Health. 

COPD is an umbrella term for chronic bronchitis and emphysema and is classically associated with a chronic inflammation of the respiratory system. 90% of cases are caused by cigarette smoking with the remaining 10% attributed to environmental factors such as air pollution. In simplistic terms, the pathology of COPD is centered around an increased amount of mucus in the airways and destruction of the alveoli resulting in an overall decreased airflow. This results in the individual experiencing a excessive repetitive cough, which includes exhaling sputum, overall decreased ability to perform daily physical activities and tightness of the chest. Treatment is centered around inhaled corticosteriods, mucolytics, smoking cessation and antibiotics to treat reoccurring respiratory infections. Oxygen therapy is often the last therapeutic option as lung transplants are rarely available and often not medically possible in older COPD patients. 

Flickr - aljarodiah for ever 

However these are only statistics and facts. Having had the pleasure of working with COPD patients in a weekly drop in support session, provided by the National Health Service Greater Glasgow and Clyde between 2011 and 2013, the reality of this disease is very grim in nature. 

When referring back to my work I often like to refer to 2 specific cases which are equally as interesting but illustrate the disconsolateness that often faces COPD patients. 

The first is a male under the age of 50 years, who’s COPD was so advanced that he required a lung transplant. During this period of time we heard that the reason he smoked which was a combination of the bereavement of a loved one and unemployment leaving him little social life. We also witnessed the individual attend smoking cessation classes but struggle to maintain a smoke free life. Unfortunately the individual also fought reoccurring respiratory infections and there was little information regarding the clients progress thereafter as he stopped attending the service. 

On the other side of the spectrum we had one older adult suffering from COPD who frequently visited the drop in session with her husband. The individual hadn’t smoked throughout her life and previously lived a very physically active lifestyle. This therefore suggests that there may be environmental factors or even a genetic influence which may have contributed to the development of the chronic disease. However she was struck down with COPD and she had to adapt her older adulthood years to using a wheelchair and tackling severely debilitating re-occurring respiratory infections. Her husband was left single handedly to care for his wife and I witnessed the physical and mental burden which being a full time carer can be. 

Flickr - Derrick.g.Robbins

So what does the future hold for an unglamorous chronic disease like COPD with a limited therapeutic index and wide psycho-social limitations ? 

Well in developed countries like the UK there is an increase in community based interventions, such as those seen in my case. These ‘drop in sessions’ set up in local environments such as libraries and community centres, allow suffers and carers to seek advise and share experiences with like minded others. There are also great initiatives to engage male COPD suffers where football clubs and the health services work together to create community based projects such as ‘The RESULTS program’. Overall reliance on community based interventions will increase, as they are not only cost effective for health services but they are also practical for COPD patients. It is a great mental and physical burden on COPD patients to visit hospitals, with the vast majority knowing that the standard procedure of an overnight observation and a dose of antibiotics will be automatically administered. Even though it is important to seek medical advise when seeking exacerbation of symptoms, a local medical practice could easily prescribe this additional pharmaceutical treatment. Therefore having a local base in the community where COPD patients can visit in relative ease and be among local COPD related individuals is a key part of the puzzle to helping those who suffer from this chronic illness, and enable them to manage their symptoms to best of their ability.  

Of course this is only referring to developed countries. Where COPD’s future really gets interesting, from a Global Health perspective, is in developing countries. It is alarming to find that 50% of the 2.7 million COPD deaths worldwide occur in China and a further 24% in India (Merson, Black & Mills, 2012). To add to this, these two countries are among those which have 5 to 10 times the concentrations of particulate matter according to WHO air pollution guidelines. Therefore should we be focussing on air pollution as a key contributor to developing this chronic illness ? 

Flickr - Dennis Wong

The jury is still out on that one. Regardless COPD is a global health issue which deserves more attention. Unfortunately with limited therapeutic options and the possible link with air pollution, it is a disease which is here to stay and may continue to affect more and more individuals in the future. It’s an area which I feel very privileged to have had such a rich experience in my hometown. However this is only the start, as COPD is a illness which is close to my interests and I passionately feel should be much higher on the NCD agenda.

The ‘Spotlight Series‘ aims to focus on non glamorous diseases or challenges which don’t necessarily receive much of the limelight in Global Health. These are often health issues which are hard hitting, symptomatically bleak in nature or outcome but should receive much more focus due to the serious threat they pose globally.